Provider Demographics
NPI:1588688097
Name:QUEENS COLLEGE SPEECH LANGUAGE HEARING CENTER
Entity type:Organization
Organization Name:QUEENS COLLEGE SPEECH LANGUAGE HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAAT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:718-997-2940
Mailing Address - Street 1:6530 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1575
Mailing Address - Country:US
Mailing Address - Phone:718-997-2930
Mailing Address - Fax:718-997-2935
Practice Address - Street 1:6530 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1575
Practice Address - Country:US
Practice Address - Phone:718-997-2930
Practice Address - Fax:718-997-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000693-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherUNITED HEALTH CARE
NY04709Medicare ID - Type Unspecified