Provider Demographics
NPI:1790821825
Name:BAKST, YAEL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:YAEL
Middle Name:
Last Name:BAKST
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 1:13610 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2328
Mailing Address - Country:US
Mailing Address - Phone:718-793-3382
Mailing Address - Fax:
Practice Address - Street 1:13610 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2328
Practice Address - Country:US
Practice Address - Phone:718-793-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009543-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist