MEDICARE: MS. MARILYN DUCKOFF M.S., 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	009528-1	NY

General Provider Information

NPI Number	:	1093070856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN DUCKOFF M.S., CCC.SLP

Provider Business Mailing Address
First Line	:	165 CARROLL ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2002
Country	:	US
Telephone Number	:	718-596-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6204
Country	:	US
Telephone Number	:	718-237-8833
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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