Healthcare Provider Details

I. General information

NPI: 1902107642
Provider Name (Legal Business Name): EMILY LISL DONLEAVY MS SLP TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 MT HOPE RD
MIDDLETOWN NY
10940-7135
US

IV. Provider business mailing address

83 HUDSON ST APT 4
PORT JERVIS NY
12771-1447
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-2292
  • Fax:
Mailing address:
  • Phone: 845-551-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: