Provider Demographics
NPI:1376783456
Name:LEVI, ILENE AMBER (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:AMBER
Last Name:LEVI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 ALBERT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850
Mailing Address - Country:US
Mailing Address - Phone:732-543-2263
Mailing Address - Fax:732-543-2263
Practice Address - Street 1:4015 15TH AVENUE
Practice Address - Street 2:CHILDRENS PLACE MANAGEMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:718-633-7728
Practice Address - Fax:718-633-7726
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013972-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist