Provider Demographics
NPI:1699558353
Name:DWORKIS, IVRIELLE M (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:IVRIELLE
Middle Name:M
Last Name:DWORKIS
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 1:13-11 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6201
Mailing Address - Country:US
Mailing Address - Phone:646-241-6766
Mailing Address - Fax:
Practice Address - Street 1:13-11 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6201
Practice Address - Country:US
Practice Address - Phone:646-241-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00744300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12154630OtherAMERICAN SPEECH/LANGUAGE HEARING ASSOCIATION (ASHA)