Provider Demographics
NPI:1790071827
Name:REICH, SHOSHANA (MS CCC SLP TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:MS CCC SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 AVENUE I
Mailing Address - Street 2:APT 510
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3049
Mailing Address - Country:US
Mailing Address - Phone:718-253-0712
Mailing Address - Fax:
Practice Address - Street 1:1615 AVENUE I
Practice Address - Street 2:APT 510
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3049
Practice Address - Country:US
Practice Address - Phone:718-253-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist