Provider Demographics
NPI:1336508126
Name:FROEHLICH, GENNA ALLISON (MS CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MS
First Name:GENNA
Middle Name:ALLISON
Last Name:FROEHLICH
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5723
Mailing Address - Country:US
Mailing Address - Phone:516-238-7305
Mailing Address - Fax:
Practice Address - Street 1:177 MURRAY DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5723
Practice Address - Country:US
Practice Address - Phone:516-238-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025463-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist