Provider Demographics
NPI:1285292532
Name:FLEISCHER, JOAN PAULINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:PAULINE
Last Name:FLEISCHER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W 190TH ST APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4131
Mailing Address - Country:US
Mailing Address - Phone:301-787-5942
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 809
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1666
Practice Address - Country:US
Practice Address - Phone:212-304-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026219-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist