Provider Demographics
NPI:1942588371
Name:BEVILACQUA, KRISTINA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:BEVILACQUA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:TAGLIARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 SHELDON PL
Mailing Address - Street 2:COMMACK
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3234
Mailing Address - Country:US
Mailing Address - Phone:516-263-9185
Mailing Address - Fax:
Practice Address - Street 1:37 SHELDON PL
Practice Address - Street 2:COMMACK
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3234
Practice Address - Country:US
Practice Address - Phone:516-263-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist