Provider Demographics
NPI:1356659726
Name:ZIRKIYEV, LARISA (MA, CCC-SLP TSLD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:ZIRKIYEV
Suffix:
Gender:F
Credentials:MA, CCC-SLP TSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 72ND RD APT LL4
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4670
Mailing Address - Country:US
Mailing Address - Phone:718-263-3363
Mailing Address - Fax:718-263-3361
Practice Address - Street 1:11215 72ND RD APT LL4
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4670
Practice Address - Country:US
Practice Address - Phone:718-263-3363
Practice Address - Fax:718-263-3361
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist