Provider Demographics
NPI:1851653323
Name:ZUCKERMAN, BRETT LAUREN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BRETT
Middle Name:LAUREN
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:BRETT
Other - Middle Name:LAUREN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:80 WAGNER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1730
Mailing Address - Country:US
Mailing Address - Phone:845-855-2175
Mailing Address - Fax:845-855-4134
Practice Address - Street 1:80 WAGNER DR
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1730
Practice Address - Country:US
Practice Address - Phone:845-855-2175
Practice Address - Fax:845-855-4134
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012655-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist