Provider Demographics
NPI:1356604425
Name:REYNOLDS, ERIN DOREEN (MS, CCC SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DOREEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6035
Mailing Address - Country:US
Mailing Address - Phone:718-476-7163
Mailing Address - Fax:
Practice Address - Street 1:7024 47TH AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6035
Practice Address - Country:US
Practice Address - Phone:718-476-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0219451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist