Provider Demographics
NPI:1255671210
Name:GROSSMAN, WENDY S (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:S
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DOSORIS LANE
Mailing Address - Street 2:DEASY SCHOOL GLEN COVE SCHOOL DISTRICT
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-801-7110
Mailing Address - Fax:516-801-7119
Practice Address - Street 1:2 DOSORIS LANE
Practice Address - Street 2:DEASY SCHOOL GLEN COVE SCHOOL DISTRICT
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-801-7110
Practice Address - Fax:516-801-7119
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002907-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist