Provider Demographics
NPI:1124337696
Name:BABB, MAXINE PRIESTLEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:PRIESTLEY
Last Name:BABB
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 1:18 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1003
Mailing Address - Country:US
Mailing Address - Phone:516-623-1277
Mailing Address - Fax:
Practice Address - Street 1:185 PENINSULA BLVD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4900
Practice Address - Country:US
Practice Address - Phone:516-292-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist