Provider Demographics
NPI:1568850824
Name:LANDSMAN, BAYLA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BAYLA
Middle Name:
Last Name:LANDSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JUMPING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3821
Mailing Address - Country:US
Mailing Address - Phone:248-219-7634
Mailing Address - Fax:
Practice Address - Street 1:23 JUMPING BROOK DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3821
Practice Address - Country:US
Practice Address - Phone:248-219-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00875200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist