Provider Demographics
NPI:1407001753
Name:HERTEL, MAGDALENA B (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MAGDALENA
Middle Name:B
Last Name:HERTEL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:MAGDALENA
Other - Middle Name:
Other - Last Name:ZELEZIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:265 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2311
Mailing Address - Country:US
Mailing Address - Phone:518-561-9858
Mailing Address - Fax:
Practice Address - Street 1:185 MARGARET ST
Practice Address - Street 2:STE 1000
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1837
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:518-561-6367
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist