Provider Demographics
NPI:1578853081
Name:TIMKO, JUSTINE G (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:G
Last Name:TIMKO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:GIDICSIN
Other - Last Name:TIMKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:89 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3507
Mailing Address - Country:US
Mailing Address - Phone:718-630-5957
Mailing Address - Fax:718-630-5139
Practice Address - Street 1:89 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3507
Practice Address - Country:US
Practice Address - Phone:718-630-5957
Practice Address - Fax:718-630-5139
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist