Provider Demographics
NPI:1376849463
Name:DEPASQUALE, LOIS ANN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ANN
Last Name:DEPASQUALE
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 1:16663 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4007
Mailing Address - Country:US
Mailing Address - Phone:718-281-0285
Mailing Address - Fax:
Practice Address - Street 1:99 CEDAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1201
Practice Address - Country:US
Practice Address - Phone:516-203-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010573-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist