Individual
AJA SISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
65 RYBKA RD, STUYVESANT FALLS, NY 12174-7708
(845) 417-4393
Mailing address
65 RYBKA RD, PO BOX 60, STUYVESANT FALLS, NY 12174-7708
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
018261
NY
Other
Enumeration date
03/18/2009
Last updated
10/21/2016
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