Provider Demographics
NPI:1508002221
Name:ILLES, TOVA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:TOVA
Middle Name:
Last Name:ILLES
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PARKVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1112
Mailing Address - Country:US
Mailing Address - Phone:718-871-3164
Mailing Address - Fax:718-871-3164
Practice Address - Street 1:138 PARKVILLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1112
Practice Address - Country:US
Practice Address - Phone:718-871-3164
Practice Address - Fax:718-871-3164
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist