Provider Demographics
NPI:1952556219
Name:SPIWAK, STEPHEN A (CCC/SLP, TSHH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:SPIWAK
Suffix:
Gender:M
Credentials:CCC/SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5805
Mailing Address - Country:US
Mailing Address - Phone:516-551-9161
Mailing Address - Fax:
Practice Address - Street 1:2 BROOK ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5805
Practice Address - Country:US
Practice Address - Phone:516-551-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist