Provider Demographics
NPI:1891949905
Name:DISTASIO LASKIN, DOLORES A (CCC-SLP/A)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:A
Last Name:DISTASIO LASKIN
Suffix:
Gender:F
Credentials:CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CEDAR RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5417
Mailing Address - Country:US
Mailing Address - Phone:631-366-0798
Mailing Address - Fax:
Practice Address - Street 1:16 CEDAR RIDGE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5417
Practice Address - Country:US
Practice Address - Phone:631-366-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001541-1231H00000X
NY014272-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist