Provider Demographics
NPI:1205137098
Name:TELESCA, LYNNE (PHD CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:TELESCA
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FALKIRK AVENUE
Mailing Address - Street 2:POB 603
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-0603
Mailing Address - Country:US
Mailing Address - Phone:516-659-2676
Mailing Address - Fax:
Practice Address - Street 1:11 FALKIRK AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3627
Practice Address - Country:US
Practice Address - Phone:516-659-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8158235Z00000X
NJ41YS00826700235Z00000X
NY009093-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist