Provider Demographics
NPI:1295246437
Name:WEILL, ALIZA FRAYDA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:FRAYDA
Last Name:WEILL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:FRAYDA
Other - Last Name:SCHRIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:14440 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3116
Mailing Address - Country:US
Mailing Address - Phone:347-578-2157
Mailing Address - Fax:
Practice Address - Street 1:49 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2580
Practice Address - Country:US
Practice Address - Phone:718-473-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026587-1235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist