MEDICARE: MISS MICHELE BRITT KORMENDI MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12122852	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12122852	OTHER	NY	ASHA CERTIFICATION

General Provider Information

NPI Number	:	1467603555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELE BRITT KORMENDI MA, CCC-SLP

Provider Business Mailing Address
First Line	:	11011 QUEENS BLVD
Second Line	:	APT 30N
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5473
Country	:	US
Telephone Number	:	917-699-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 QUEENS BLVD
Second Line	:	APT 30N
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5473
Country	:	US
Telephone Number	:	917-699-8189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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Directions to “ MISS MICHELE BRITT KORMENDI MA, CCC-SLP” Practice Location

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