Provider Demographics
NPI:1609310093
Name:RESETAR, LORI ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:RESETAR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:RESETAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:83 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3107
Mailing Address - Country:US
Mailing Address - Phone:516-724-0333
Mailing Address - Fax:
Practice Address - Street 1:850 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1702
Practice Address - Country:US
Practice Address - Phone:718-904-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019908-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist