Provider Demographics
NPI:1952535338
Name:BAMBERGER, RISA (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:RISA
Middle Name:
Last Name:BAMBERGER
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13852 78TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3242
Mailing Address - Country:US
Mailing Address - Phone:718-380-3614
Mailing Address - Fax:
Practice Address - Street 1:13852 78TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3242
Practice Address - Country:US
Practice Address - Phone:718-380-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0119011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist