Provider Demographics
NPI:1497900864
Name:ALVARADO, WENDY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:10 HILLSIDE AVE
Mailing Address - Street 2:APT 1L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2217
Mailing Address - Country:US
Mailing Address - Phone:646-998-5111
Mailing Address - Fax:646-998-5111
Practice Address - Street 1:10 HILLSIDE AVE
Practice Address - Street 2:APT 1L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2217
Practice Address - Country:US
Practice Address - Phone:646-998-5111
Practice Address - Fax:646-998-5111
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04596425Medicaid