Provider Demographics
NPI:1215182852
Name:NORMAN, VIRGINIA ALTAGRACIA (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ALTAGRACIA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-0806
Mailing Address - Country:US
Mailing Address - Phone:917-902-5221
Mailing Address - Fax:
Practice Address - Street 1:245 RUMSEY RD APT 3K
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4523
Practice Address - Country:US
Practice Address - Phone:914-376-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist