Provider Demographics
NPI:1174871362
Name:ZIELINSKI, BRENNA MARISSA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:MARISSA
Last Name:ZIELINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 AMSTERDAM AVE
Mailing Address - Street 2:APT. 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6713
Mailing Address - Country:US
Mailing Address - Phone:732-740-4579
Mailing Address - Fax:
Practice Address - Street 1:371 AMSTERDAM AVE
Practice Address - Street 2:APT. 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6713
Practice Address - Country:US
Practice Address - Phone:732-740-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist