Provider Demographics
NPI:1528785789
Name:FRIERMAN, TRACY (MS-CCC/SLP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FRIERMAN
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 1:11 WAYLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1120
Mailing Address - Country:US
Mailing Address - Phone:516-582-8633
Mailing Address - Fax:
Practice Address - Street 1:11 WAYLAND RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1120
Practice Address - Country:US
Practice Address - Phone:516-582-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007175OtherSPEECH