Provider Demographics
NPI:1972355170
Name:LESSAGE, MEDJEEN MISHAMA (SLP-CF)
Entity type:Individual
Prefix:
First Name:MEDJEEN
Middle Name:MISHAMA
Last Name:LESSAGE
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1722
Mailing Address - Country:US
Mailing Address - Phone:347-445-6807
Mailing Address - Fax:
Practice Address - Street 1:1808 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1722
Practice Address - Country:US
Practice Address - Phone:347-445-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist