Provider Demographics
NPI:1124301585
Name:SPAGNUOLO, DENISE L (MA, CCC-SLP/TSHH)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:SPAGNUOLO
Suffix:
Gender:F
Credentials:MA, 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 1:50 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4803
Mailing Address - Country:US
Mailing Address - Phone:631-434-2525
Mailing Address - Fax:631-434-2186
Practice Address - Street 1:50 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-434-2525
Practice Address - Fax:631-434-2186
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10041-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist