Provider Demographics
NPI:1063024545
Name:ZUCKER, ELLA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3602
Mailing Address - Country:US
Mailing Address - Phone:845-499-0903
Mailing Address - Fax:
Practice Address - Street 1:4 REEDER PL
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-1504
Practice Address - Country:US
Practice Address - Phone:845-521-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program