Provider Demographics
NPI:1194935486
Name:SZYMULA, ANNETTE S (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:SZYMULA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 LOCKPORT OLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:BURT
Mailing Address - State:NY
Mailing Address - Zip Code:14028-9769
Mailing Address - Country:US
Mailing Address - Phone:716-628-7227
Mailing Address - Fax:
Practice Address - Street 1:1640 LOCKPORT OLCOTT RD
Practice Address - Street 2:
Practice Address - City:BURT
Practice Address - State:NY
Practice Address - Zip Code:14028-9769
Practice Address - Country:US
Practice Address - Phone:716-628-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001389-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist