Provider Demographics
NPI:1407009681
Name:KING, JUSTINE M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:KING
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 1:444 EAST 75TH STREET
Mailing Address - Street 2:APT 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3444
Mailing Address - Country:US
Mailing Address - Phone:212-249-0416
Mailing Address - Fax:
Practice Address - Street 1:444 E 75TH ST
Practice Address - Street 2:APT 7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3444
Practice Address - Country:US
Practice Address - Phone:212-249-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist