Organization
KRISTIN BEVILACQUA, MA, CCC-SLP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN BEVILACQUA MA, CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(718) 208-9444
Entity
Organization
Contact information
Practice address
551 JEFFERSON BLVD, STATEN ISLAND, NY 10312-2225
(718) 208-9444
(718) 967-9513
Mailing address
551 JEFFERSON BLVD, STATEN ISLAND, NY 10312-2225
(718) 208-9444
(718) 967-9513
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
0164531
NY
261QH0700X
Hearing and Speech Clinic/Center
Primary
0164531
NY
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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