Provider Demographics
NPI:1538472758
Name:WAXMAN, LEORA ANN
Entity Type:Individual
Prefix:MRS
First Name:LEORA
Middle Name:ANN
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 JEWEL AVE
Mailing Address - Street 2:2C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4353
Mailing Address - Country:US
Mailing Address - Phone:718-969-5909
Mailing Address - Fax:
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:SUITE 308
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1938
Practice Address - Country:US
Practice Address - Phone:718-793-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018232-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist