Provider Demographics
NPI:1861646762
Name:TIEGEL, PAULA D (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:TIEGEL
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5314
Mailing Address - Country:US
Mailing Address - Phone:516-826-2206
Mailing Address - Fax:
Practice Address - Street 1:2958 JUDITH DR
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5314
Practice Address - Country:US
Practice Address - Phone:516-826-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist