Healthcare Provider Details

I. General information

NPI: 1134329113
Provider Name (Legal Business Name): FRIZZI LILIAN LINCK MM, MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SAINT MARKS PL HISTORIC ST. GEORGE NEIGHBORHOOD
STATEN ISLAND NY
10301-1606
US

IV. Provider business mailing address

97 SAINT MARKS PL HISTORIC ST. GEORGE NEIGHBORHOOD
STATEN ISLAND NY
10301-1606
US

V. Phone/Fax

Practice location:
  • Phone: 917-710-4148
  • Fax:
Mailing address:
  • Phone: 917-710-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017140-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: