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General NPI Number Information
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NPI Number | 1679801906
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Entity Type | Individual
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Provider Name | LAURIE JILL MULLODZHANOV MS, CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 8745 117TH ST SPEECH THERAPY OFFICE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2429
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Country | US
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Telephone | 718-850-0738
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Fax | 718-850-0830
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Provider Business Mailing Address
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Address Line | 10515 66TH RD APT 5D
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City | FOREST HILLS
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State | NY
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Zip | 11375-2173
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Country | US
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Telephone | 516-650-1804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 014847
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License Number State | NY
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