Provider Demographics
NPI:1255826533
Name:DOUECK, ROBERTA R (SLP-TSSLD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:R
Last Name:DOUECK
Suffix:
Gender:F
Credentials:SLP-TSSLD
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:R
Other - Last Name:ROSENBLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3321 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5421
Mailing Address - Country:US
Mailing Address - Phone:718-531-1800
Mailing Address - Fax:
Practice Address - Street 1:3321 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5421
Practice Address - Country:US
Practice Address - Phone:718-531-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist