Provider Demographics
NPI:1508404161
Name:KRAVIT, ILYSSA BARRIE (MS CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ILYSSA
Middle Name:BARRIE
Last Name:KRAVIT
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 W 69TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4714
Mailing Address - Country:US
Mailing Address - Phone:516-776-5618
Mailing Address - Fax:
Practice Address - Street 1:21 W 111TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-4328
Practice Address - Country:US
Practice Address - Phone:212-410-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist