Individual
ALLISON PATRICIA BASDAVANOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
100 GLEN COVE AVE, GLEN COVE, NY 11542-2818
(516) 609-2000
Mailing address
25 FRANKLIN BLVD APT 6K, LONG BEACH, NY 11561-4504
(516) 698-7886
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
021320
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03692739
—
NY
Enumeration date
09/02/2011
Last updated
06/10/2014
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