Provider Demographics
NPI:1700917465
Name:BODZIN, MINDY BETH (MA,CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:BETH
Last Name:BODZIN
Suffix:
Gender:F
Credentials:MA,CCCSLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 WESTEND AVE
Mailing Address - Street 2:UNIT 39
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5251
Mailing Address - Country:US
Mailing Address - Phone:516-378-5297
Mailing Address - Fax:516-378-5297
Practice Address - Street 1:116 WESTEND AVE
Practice Address - Street 2:UNIT 39
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5251
Practice Address - Country:US
Practice Address - Phone:516-378-5297
Practice Address - Fax:516-378-5297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011663-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist