Individual
MS. KHADEJAR T DIMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
512 CARROLL ST, BROOKLYN, NY 11215-1030
(718) 624-5271
Mailing address
870 LENOX RD, BROOKLYN, NY 11203-2519
(917) 297-4287
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
015579-1
NY
252Y00000X
Early Intervention Provider Agency
Primary
015579-1
NY
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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