Provider Demographics
NPI:1184035222
Name:NOONAN, EILEEN (MS)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4104
Mailing Address - Country:US
Mailing Address - Phone:347-247-8217
Mailing Address - Fax:
Practice Address - Street 1:184 FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4104
Practice Address - Country:US
Practice Address - Phone:347-247-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022817-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist