Provider Demographics
NPI:1689952392
Name:LEDEREICH, PEARL (MS)
Entity Type:Individual
Prefix:MISS
First Name:PEARL
Middle Name:
Last Name:LEDEREICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5037
Mailing Address - Country:US
Mailing Address - Phone:718-436-2404
Mailing Address - Fax:718-851-4530
Practice Address - Street 1:1471 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5037
Practice Address - Country:US
Practice Address - Phone:718-436-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist