Healthcare Provider Details

I. General information

NPI: 1295480440
Provider Name (Legal Business Name): ANN FICI MS CCC-SLP TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

IV. Provider business mailing address

250 LINCOLN BLVD
HAUPPAUGE NY
11788-4400
US

V. Phone/Fax

Practice location:
  • Phone: 631-226-2330
  • Fax:
Mailing address:
  • Phone: 631-559-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: