Provider Demographics
NPI:1538300587
Name:SIPERSTEIN, MYNDE SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MYNDE
Middle Name:SUE
Last Name:SIPERSTEIN
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 1:130 JOSEPH CT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9564
Mailing Address - Country:US
Mailing Address - Phone:401-885-0075
Mailing Address - Fax:401-885-2964
Practice Address - Street 1:130 JOSEPH CT
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-9564
Practice Address - Country:US
Practice Address - Phone:401-885-0075
Practice Address - Fax:401-885-2964
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist