Provider Demographics
NPI:1942999040
Name:GOUDELIAS, DEANNA EUGENIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:EUGENIA
Last Name:GOUDELIAS
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 1:7016 LOUISE TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1112
Mailing Address - Country:US
Mailing Address - Phone:718-924-0465
Mailing Address - Fax:
Practice Address - Street 1:9115 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5909
Practice Address - Country:US
Practice Address - Phone:718-836-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist