Provider Demographics
NPI:1598909442
Name:YEKATERINA DOMS SPEECH-LANGUAGE PATHOLOGY,P.C.
Entity Type:Organization
Organization Name:YEKATERINA DOMS SPEECH-LANGUAGE PATHOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:718-781-3239
Mailing Address - Street 1:2805 OCEAN PKWY
Mailing Address - Street 2:APT# 8B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7865
Mailing Address - Country:US
Mailing Address - Phone:718-781-3239
Mailing Address - Fax:
Practice Address - Street 1:2805 OCEAN PKWY
Practice Address - Street 2:APT# 8B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7865
Practice Address - Country:US
Practice Address - Phone:718-781-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011026252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency