Provider Demographics
NPI:1124801089
Name:TISO, CHLOE E
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:E
Last Name:TISO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W 91ST ST APT 24
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1137
Mailing Address - Country:US
Mailing Address - Phone:315-289-7066
Mailing Address - Fax:
Practice Address - Street 1:5550 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2418
Practice Address - Country:US
Practice Address - Phone:718-796-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist