Provider Demographics
NPI:1457668683
Name:MILEWSKI, ANN MARIE (CCC, NYS LIC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:MILEWSKI
Suffix:
Gender:F
Credentials:CCC, NYS LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 DATUM LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6201
Mailing Address - Country:US
Mailing Address - Phone:315-695-1561
Mailing Address - Fax:
Practice Address - Street 1:11 ELM ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-1922
Practice Address - Country:US
Practice Address - Phone:315-695-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006666-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006666-1OtherNY STATE LICENSE
01095478OtherASHA CERTIFICATION