Provider Demographics
NPI:1194965962
Name:GALLOWAY, LATASHA RENEE (SLP)
Entity type:Individual
Prefix:MS
First Name:LATASHA
Middle Name:RENEE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:LATASHA
Other - Middle Name:RENEE
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:11536 149TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1122
Mailing Address - Country:US
Mailing Address - Phone:718-529-4696
Mailing Address - Fax:718-529-4696
Practice Address - Street 1:11536 149TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1122
Practice Address - Country:US
Practice Address - Phone:718-529-4696
Practice Address - Fax:718-529-4696
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016841-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist