MEDICARE: KATE KALENSKY 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	019309	NY

General Provider Information

NPI Number	:	1700220506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE KALENSKY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4502 DITMARS BLVD
Second Line	:	APARTMENT 126
City	:	ASTORIA
State	:	NY
Zip	:	11105-1319
Country	:	US
Telephone Number	:	718-781-2239
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 DITMARS BLVD
Second Line	:	APARTMENT 126
City	:	ASTORIA
State	:	NY
Zip	:	11105-1319
Country	:	US
Telephone Number	:	718-781-2239
Fax Number	:

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

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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