Provider Demographics
NPI:1396012001
Name:MANCZ, LINDA (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:MANCZ
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4742
Mailing Address - Country:US
Mailing Address - Phone:516-396-2255
Mailing Address - Fax:516-396-2467
Practice Address - Street 1:71 CLINTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4742
Practice Address - Country:US
Practice Address - Phone:516-396-2255
Practice Address - Fax:516-396-2467
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist