Provider Demographics
NPI:1528480092
Name:SCHAEFER, DOREEN (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2306
Mailing Address - Country:US
Mailing Address - Phone:631-374-8335
Mailing Address - Fax:
Practice Address - Street 1:20 ORMOND AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-2306
Practice Address - Country:US
Practice Address - Phone:631-374-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist