Provider Demographics
NPI:1992851414
Name:HOUGHTALEN, NANCY THERESA (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:THERESA
Last Name:HOUGHTALEN
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 1:121 MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1846
Mailing Address - Country:US
Mailing Address - Phone:631-563-1159
Mailing Address - Fax:
Practice Address - Street 1:121 MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1846
Practice Address - Country:US
Practice Address - Phone:631-563-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009623-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist