Provider Demographics
NPI:1184167769
Name:KOPYLENKOKORROL, OLENA
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:KOPYLENKOKORROL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WEST AVE # IS303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4220
Mailing Address - Country:US
Mailing Address - Phone:718-996-0110
Mailing Address - Fax:718-996-3785
Practice Address - Street 1:501 WEST AVE # IS303
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4220
Practice Address - Country:US
Practice Address - Phone:718-996-0110
Practice Address - Fax:718-996-3785
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023284-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist