Provider Demographics
NPI:1710132477
Name:KOGAN, LYUDMILA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:KOGAN
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 1:6259 108TH ST
Mailing Address - Street 2:APT.5G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1357
Mailing Address - Country:US
Mailing Address - Phone:917-650-4645
Mailing Address - Fax:718-896-0243
Practice Address - Street 1:6259 108TH ST
Practice Address - Street 2:APT.5G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1357
Practice Address - Country:US
Practice Address - Phone:917-650-4645
Practice Address - Fax:718-896-0243
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist