Provider Demographics
NPI:1366674335
Name:KIRKOWSKI, ANN RAYMONDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:RAYMONDA
Last Name:KIRKOWSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RAYMONDA
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223A SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1717
Mailing Address - Country:US
Mailing Address - Phone:973-729-9503
Mailing Address - Fax:
Practice Address - Street 1:220 WHITE PLAINS RD
Practice Address - Street 2:STE. 550
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5837
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00580600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist