Provider Demographics
NPI:1659626174
Name:FELDER, VICKI (MS,CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:FELDER
Suffix:
Gender:F
Credentials:MS,CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 PROSPECT PARK SW APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1270
Mailing Address - Country:US
Mailing Address - Phone:917-803-7943
Mailing Address - Fax:
Practice Address - Street 1:500 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6204
Practice Address - Country:US
Practice Address - Phone:718-237-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007162-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist