Provider Demographics
NPI:1235552530
Name:EDWARD D. MYSAK CLINIC FOR COMMUNICATION DISORDERS
Entity Type:Organization
Organization Name:EDWARD D. MYSAK CLINIC FOR COMMUNICATION DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC-SLP
Authorized Official - Phone:212-678-3410
Mailing Address - Street 1:525 W 120TH ST
Mailing Address - Street 2:BOX 191
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6605
Mailing Address - Country:US
Mailing Address - Phone:212-678-3409
Mailing Address - Fax:
Practice Address - Street 1:525 W 120TH ST
Practice Address - Street 2:BOX 191
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6605
Practice Address - Country:US
Practice Address - Phone:212-678-3409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty