Provider Demographics
NPI:1255689873
Name:LOBANOV, YELENA (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:LOBANOV
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 AVENUE V
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4555
Mailing Address - Country:US
Mailing Address - Phone:646-912-2551
Mailing Address - Fax:
Practice Address - Street 1:2020 AVENUE V
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4555
Practice Address - Country:US
Practice Address - Phone:646-912-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist