Provider Demographics
NPI:1851979173
Name:BUCKLEY, NANCY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 DEGRAW ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3713
Mailing Address - Country:US
Mailing Address - Phone:201-414-8008
Mailing Address - Fax:
Practice Address - Street 1:1110 2ND AVE RM 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2021
Practice Address - Country:US
Practice Address - Phone:212-842-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist