Provider Demographics
NPI:1972758654
Name:BATTISTE, DOMINIQUE (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:
Last Name:BATTISTE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:BATTISTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3 BUCKS HILL ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1574
Mailing Address - Country:US
Mailing Address - Phone:516-972-6695
Mailing Address - Fax:
Practice Address - Street 1:3 BUCKS HILL ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1574
Practice Address - Country:US
Practice Address - Phone:516-972-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009792-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist