Provider Demographics
NPI:1972745305
Name:BLOCK, JUSTINE M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:M
Last Name:BLOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:32 DOUGLAS LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1514
Mailing Address - Country:US
Mailing Address - Phone:914-582-6655
Mailing Address - Fax:203-244-5826
Practice Address - Street 1:32 DOUGLAS LN
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-1514
Practice Address - Country:US
Practice Address - Phone:914-582-6655
Practice Address - Fax:203-244-5826
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011783235Z00000X
CT004086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist