Provider Demographics
NPI:1659772572
Name:GRUEN, BAILA C (MS SLP-CFY)
Entity Type:Individual
Prefix:
First Name:BAILA
Middle Name:C
Last Name:GRUEN
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619-18 AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:347-860-2316
Mailing Address - Fax:718-677-7123
Practice Address - Street 1:4619-18 AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:347-860-2316
Practice Address - Fax:718-677-7123
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist