Provider Demographics
NPI:1851884027
Name:LESSER, IVY (MS ED, MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:LESSER
Suffix:
Gender:F
Credentials:MS ED, 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 1:233 E. 56 STREET
Mailing Address - Street 2:SPEECH ROOM 211
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:646-231-6280
Mailing Address - Fax:
Practice Address - Street 1:233 E. 56 STREET
Practice Address - Street 2:SPEECH ROOM 211
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:646-231-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist