Provider Demographics
NPI:1801026547
Name:DESTIN, NIQUETTE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:NIQUETTE
Middle Name:
Last Name:DESTIN
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22004 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1621
Mailing Address - Country:US
Mailing Address - Phone:718-712-3358
Mailing Address - Fax:888-352-0588
Practice Address - Street 1:22004 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1621
Practice Address - Country:US
Practice Address - Phone:718-712-3358
Practice Address - Fax:718-712-3379
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 1041C0700X, 235Z00000X
NY016079-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical