Provider Demographics
NPI:1356783781
Name:KING, BRENDA BUDZITOWSKI (SLP, MSW)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:BUDZITOWSKI
Last Name:KING
Suffix:
Gender:F
Credentials:SLP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WOLF HILL RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1340
Mailing Address - Country:US
Mailing Address - Phone:631-271-0777
Mailing Address - Fax:631-271-0999
Practice Address - Street 1:175 WOLF HILL RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1340
Practice Address - Country:US
Practice Address - Phone:631-271-0777
Practice Address - Fax:631-271-0999
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006124-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY097014OtherMSW