Provider Demographics
NPI:1306453469
Name:REILLY, MARGUERITE (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57-12 94TH STREET
Mailing Address - Street 2:SPEECH SUITE
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-760-1083
Mailing Address - Fax:718-760-1920
Practice Address - Street 1:P721Q JOHN F. KENNEDY SCHOOL @ INFORMATION TECHNOLOGY H
Practice Address - Street 2:21-16 44TH ROAD
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-937-1682
Practice Address - Fax:718-937-1847
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist