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Individual

ALAN BANNISTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA SLP-CCC

Contact information

Practice address
2419 19TH ST APT 2, ASTORIA, NY 11102-3442
(614) 843-1082
Mailing address
2419 19TH ST APT 2, ASTORIA, NY 11102-3442
(614) 843-1082

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
029461
NY

Other

Enumeration date
08/19/2020
Last updated
07/07/2023
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