Provider Demographics
NPI:1215247598
Name:SCHULTZ, MIMI DRYCE (MS, CCC, SLP)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:DRYCE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 FRANKEL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5054
Mailing Address - Country:US
Mailing Address - Phone:516-455-6032
Mailing Address - Fax:
Practice Address - Street 1:56 CATHEDRAL AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2819
Practice Address - Country:US
Practice Address - Phone:516-478-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3391-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist