Provider Demographics
NPI:1598259830
Name:KORETZKY, NECHAMA MALKA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NECHAMA
Middle Name:MALKA
Last Name:KORETZKY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:KORETZKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1205 NORTH BELGRADE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902
Mailing Address - Country:US
Mailing Address - Phone:443-414-8220
Mailing Address - Fax:
Practice Address - Street 1:1205 NORTH BELGRADE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:443-414-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12092500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist