Provider Demographics
NPI:1699052282
Name:SIEGLER, JOYCE REGINA (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:REGINA
Last Name:SIEGLER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESLEYAN CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3011
Mailing Address - Country:US
Mailing Address - Phone:631-864-4911
Mailing Address - Fax:
Practice Address - Street 1:10 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1501
Practice Address - Country:US
Practice Address - Phone:516-644-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist