Provider Demographics
NPI:1457944910
Name:REZNICHENKO, EKATERINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:REZNICHENKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1405
Mailing Address - Country:US
Mailing Address - Phone:603-966-1941
Mailing Address - Fax:
Practice Address - Street 1:48 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1405
Practice Address - Country:US
Practice Address - Phone:603-966-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist