Provider Demographics
NPI:1255794640
Name:POLESHUCK, DEBORAH S (CCC/SLP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:POLESHUCK
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 1:85 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1674
Mailing Address - Country:US
Mailing Address - Phone:718-619-2627
Mailing Address - Fax:
Practice Address - Street 1:85 WALNUT ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1674
Practice Address - Country:US
Practice Address - Phone:718-619-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002030-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist