Provider Demographics
NPI:1518108018
Name:PLUMMER, KEZIA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KEZIA
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 E 72ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5325
Mailing Address - Country:US
Mailing Address - Phone:917-817-7865
Mailing Address - Fax:
Practice Address - Street 1:1083 E 72ND ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5325
Practice Address - Country:US
Practice Address - Phone:917-817-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist