Provider Demographics
NPI:1225628480
Name:BAK, DEVORAH (SLP)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:BAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LOCUST HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2410
Mailing Address - Country:US
Mailing Address - Phone:845-596-6786
Mailing Address - Fax:
Practice Address - Street 1:27 LOCUST HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2410
Practice Address - Country:US
Practice Address - Phone:845-596-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist