Provider Demographics
NPI:1770621195
Name:SADOWSKI-SIMM, LYNN (MA, CCCSLP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SADOWSKI-SIMM
Suffix:
Gender:F
Credentials:MA, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1823
Mailing Address - Country:US
Mailing Address - Phone:516-674-0156
Mailing Address - Fax:
Practice Address - Street 1:189 WHEATLEY RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-2641
Practice Address - Country:US
Practice Address - Phone:516-626-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011365-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist