Provider Demographics
NPI:1972360311
Name:LIRD, GIANNINA ALEXA (CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:GIANNINA
Middle Name:ALEXA
Last Name:LIRD
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3423
Mailing Address - Country:US
Mailing Address - Phone:516-724-4471
Mailing Address - Fax:
Practice Address - Street 1:3420 94TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3824
Practice Address - Country:US
Practice Address - Phone:718-424-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist