Individual
MRS. CHRISTINE IADEVIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
79 RIVERSIDE AVE, MASSAPEQUA, NY 11758-5128
(516) 809-6143
Mailing address
79 RIVERSIDE AVE, MASSAPEQUA, NY 11758-5128
(516) 809-6143
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
006461-1
NY
Other
Enumeration date
08/21/2010
Last updated
08/21/2010
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