Provider Demographics
NPI:1669613295
Name:FOGEL, LEAH (SLP)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:TOBY
Other - Last Name:SCHACHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1453 EAST 12 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6605
Mailing Address - Country:US
Mailing Address - Phone:718-753-4184
Mailing Address - Fax:718-252-2472
Practice Address - Street 1:1453 EAST 12 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6605
Practice Address - Country:US
Practice Address - Phone:718-753-4184
Practice Address - Fax:718-252-2472
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist