Provider Demographics
NPI:1316183296
Name:DORFMAN-SIEGEL, JODI M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:M
Last Name:DORFMAN-SIEGEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GARTH CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6136
Mailing Address - Country:US
Mailing Address - Phone:917-684-8244
Mailing Address - Fax:
Practice Address - Street 1:20 GARTH CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6136
Practice Address - Country:US
Practice Address - Phone:917-684-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005070-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist