Provider Demographics
NPI:1386767408
Name:LENZ, DESSARAE A'SHELL (MSSLP-CCC)
Entity type:Individual
Prefix:MISS
First Name:DESSARAE
Middle Name:A'SHELL
Last Name:LENZ
Suffix:
Gender:F
Credentials:MSSLP-CCC
Other - Prefix:MISS
Other - First Name:DESSARAE
Other - Middle Name:A'SHELL
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SLP-CCC
Mailing Address - Street 1:338 ELMWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2228
Mailing Address - Country:US
Mailing Address - Phone:716-397-8362
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8318
Practice Address - Fax:716-885-0229
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016216-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist