Provider Demographics
NPI:1851625123
Name:HETZEL-DAND, DORINE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DORINE
Middle Name:
Last Name:HETZEL-DAND
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 1:290 KILBURN RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5325
Mailing Address - Country:US
Mailing Address - Phone:516-456-0746
Mailing Address - Fax:
Practice Address - Street 1:290 KILBURN RD S
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5325
Practice Address - Country:US
Practice Address - Phone:516-456-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist