Provider Demographics
NPI:1003195223
Name:REILLY, ERIN LYNN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:LYNN
Last Name:REILLY
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 1:5128 30TH AVE
Mailing Address - Street 2:APT 3H
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7953
Mailing Address - Country:US
Mailing Address - Phone:631-848-7992
Mailing Address - Fax:
Practice Address - Street 1:5128 30TH AVE
Practice Address - Street 2:APT 3H
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7953
Practice Address - Country:US
Practice Address - Phone:631-848-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0199631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist