Provider Demographics
NPI:1740328517
Name:WALZ, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:WALZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5020
Mailing Address - Country:US
Mailing Address - Phone:516-488-0663
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4213
Practice Address - Country:US
Practice Address - Phone:516-877-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist