Provider Demographics
NPI:1215214218
Name:KLEIN, PHYLLIS D (MSCCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:D
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 JACKSON AVENUE
Mailing Address - Street 2:MINEOLA UNION FREE SCHOOL DISTRICT
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-237-2200
Mailing Address - Fax:
Practice Address - Street 1:121 JACKSON AVE.
Practice Address - Street 2:MINEOLA UNION FREE SCHOOL DISTRICT
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-237-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25130000OtherMINEOLA UFSD