Provider Demographics
NPI:1811515703
Name:HERMAN, ILANA (SPEECHPATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:ILANA
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:SPEECHPATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 HUDSON MANOR TER APT 2FE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1130
Mailing Address - Country:US
Mailing Address - Phone:917-428-9495
Mailing Address - Fax:
Practice Address - Street 1:3750 HUDSON MANOR TER APT 2FE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1130
Practice Address - Country:US
Practice Address - Phone:917-428-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002836-12355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant