Provider Demographics
NPI:1689950800
Name:RIZZI HAMILTON, KIM C (SLP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:RIZZI HAMILTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLD WOOD RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1029
Mailing Address - Country:US
Mailing Address - Phone:516-818-4811
Mailing Address - Fax:
Practice Address - Street 1:678 CANTIAGUE ROCK RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1401
Practice Address - Country:US
Practice Address - Phone:516-203-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58007848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist