Provider Demographics
NPI:1174821557
Name:SEEDORF, LYSETTE ROSE (MS-SLP)
Entity Type:Individual
Prefix:MS
First Name:LYSETTE
Middle Name:ROSE
Last Name:SEEDORF
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 COMMERCE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4442
Mailing Address - Country:US
Mailing Address - Phone:845-392-3511
Mailing Address - Fax:
Practice Address - Street 1:1811 COMMERCE ST
Practice Address - Street 2:APT 2
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4442
Practice Address - Country:US
Practice Address - Phone:845-392-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020736-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist