Provider Demographics
NPI:1316905086
Name:IPPOLITO-MICEK, MILENA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MILENA
Middle Name:
Last Name:IPPOLITO-MICEK
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 1:800 POLY PL # 126
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-630-3745
Mailing Address - Fax:718-630-3697
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:(126)
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:781-630-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006283-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist