Provider Demographics
NPI:1922301100
Name:DALLAL, RHONDA LEE (MA, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LEE
Last Name:DALLAL
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 1:14 KENNILWORTH TER
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1206
Mailing Address - Country:US
Mailing Address - Phone:516-487-8956
Mailing Address - Fax:
Practice Address - Street 1:14 KENNILWORTH TER
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1206
Practice Address - Country:US
Practice Address - Phone:516-236-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002345-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist