Provider Demographics
NPI:1588176291
Name:GOTTESMAN, YAEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:YAEL
Other - Middle Name:
Other - Last Name:LEFKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:935 STERNER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3005
Mailing Address - Country:US
Mailing Address - Phone:305-905-9775
Mailing Address - Fax:
Practice Address - Street 1:935 STERNER RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-3005
Practice Address - Country:US
Practice Address - Phone:305-905-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00837100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist