Provider Demographics
NPI:1518264340
Name:MEDINA, LAKISHA MONIQUE (CCC-SLP,TSHH)
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:MONIQUE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:CCC-SLP,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PATMORE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5435
Mailing Address - Country:US
Mailing Address - Phone:914-261-6292
Mailing Address - Fax:
Practice Address - Street 1:78 PATMORE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5435
Practice Address - Country:US
Practice Address - Phone:914-261-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014400-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist