Provider Demographics
NPI:1497981690
Name:SCHUBACH, EILEEN ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANN
Last Name:SCHUBACH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 207TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1067
Mailing Address - Country:US
Mailing Address - Phone:917-848-8712
Mailing Address - Fax:
Practice Address - Street 1:9065 207TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1067
Practice Address - Country:US
Practice Address - Phone:917-848-8712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017593-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist