Provider Demographics
NPI:1538314364
Name:ADLER, RANDI ALYSSA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:ALYSSA
Last Name:ADLER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EAST BROADWAY
Mailing Address - Street 2:APARTMENT 6V
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-889-1073
Mailing Address - Fax:
Practice Address - Street 1:410 EAST BROADWAY
Practice Address - Street 2:APARTMENT 6V
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-889-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013548-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist