Provider Demographics
NPI:1427306372
Name:WILNER, AVIVA (SLP)
Entity type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:
Last Name:WILNER
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 1:3850 HUDSON MANOR TER
Mailing Address - Street 2:APT 1AE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1117
Mailing Address - Country:US
Mailing Address - Phone:914-942-1440
Mailing Address - Fax:
Practice Address - Street 1:3850 HUDSON MANOR TER
Practice Address - Street 2:APT 1AE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1117
Practice Address - Country:US
Practice Address - Phone:914-942-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022926-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist