Provider Demographics
NPI:1700022837
Name:LOWE, WANDA A (MA-CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:A
Last Name:LOWE
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14963 256TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2701
Mailing Address - Country:US
Mailing Address - Phone:516-641-8851
Mailing Address - Fax:
Practice Address - Street 1:14963 256TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2701
Practice Address - Country:US
Practice Address - Phone:516-641-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013962-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist