Provider Demographics
NPI:1477830537
Name:YEGIDIS, WENDY JILL (CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JILL
Last Name:YEGIDIS
Suffix:
Gender:F
Credentials:CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2428
Mailing Address - Country:US
Mailing Address - Phone:516-665-8185
Mailing Address - Fax:
Practice Address - Street 1:2616 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3131
Practice Address - Country:US
Practice Address - Phone:516-992-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58012008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist