Provider Demographics
NPI:1457660342
Name:KATSNELSON, DORA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:KATSNELSON
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 1:750 KAPPOCK ST
Mailing Address - Street 2:APT.# 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4612
Mailing Address - Country:US
Mailing Address - Phone:347-346-1569
Mailing Address - Fax:
Practice Address - Street 1:511 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2737
Practice Address - Country:US
Practice Address - Phone:516-565-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019652-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0414988103OtherCNA