Provider Demographics
NPI:1417474206
Name:FERNANDEZ-EBERT, MONICA R (MA CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:R
Last Name:FERNANDEZ-EBERT
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2809
Mailing Address - Country:US
Mailing Address - Phone:917-912-6590
Mailing Address - Fax:914-328-2973
Practice Address - Street 1:115 HIGH ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2809
Practice Address - Country:US
Practice Address - Phone:917-912-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty