Provider Demographics
NPI:1396989554
Name:LEVITT, LUISA EBANKS (SLP)
Entity type:Individual
Prefix:MRS
First Name:LUISA
Middle Name:EBANKS
Last Name:LEVITT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 35TH AVE
Mailing Address - Street 2:APT3F
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5453
Mailing Address - Country:US
Mailing Address - Phone:718-391-8411
Mailing Address - Fax:
Practice Address - Street 1:8412 35TH AVE
Practice Address - Street 2:APT3F
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5453
Practice Address - Country:US
Practice Address - Phone:718-391-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008529-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist