MEDICARE: MRS. LAURIE JILL MULLODZHANOV MS, 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	014847	NY

General Provider Information

NPI Number	:	1679801906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE JILL MULLODZHANOV MS, CCC/SLP

Provider Business Mailing Address
First Line	:	10515 66TH RD APT 5D
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2173
Country	:	US
Telephone Number	:	516-650-1804
Fax Number	:

Provider Business Practice Location Address
First Line	:	8745 117TH ST
Second Line	:	SPEECH THERAPY OFFICE
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2429
Country	:	US
Telephone Number	:	718-850-0738
Fax Number	:	718-850-0830

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	02/01/2017

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Directions to “ MRS. LAURIE JILL MULLODZHANOV MS, CCC/SLP” Practice Location

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