Provider Demographics
NPI:1801033279
Name:CONVERY-BERNARD, DEIDRE M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:M
Last Name:CONVERY-BERNARD
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:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:NORTH CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12853-0210
Mailing Address - Country:US
Mailing Address - Phone:845-453-7268
Mailing Address - Fax:
Practice Address - Street 1:301 COBBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853
Practice Address - Country:US
Practice Address - Phone:845-453-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist