Provider Demographics
NPI:1932424637
Name:GLIKSTEIN, VIOLETTA (SLP)
Entity Type:Individual
Prefix:MS
First Name:VIOLETTA
Middle Name:
Last Name:GLIKSTEIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CLEMATIS AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7012
Mailing Address - Country:US
Mailing Address - Phone:347-792-3665
Mailing Address - Fax:
Practice Address - Street 1:32 WHITES AVE APT F5503
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4305
Practice Address - Country:US
Practice Address - Phone:347-782-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY019362235Z00000X
MA8099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty