Provider Demographics
NPI:1245661347
Name:FRIEDMAN, REVA
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:
Last Name:FRIEDMAN
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 1:1823 ATTAYA RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2902
Mailing Address - Country:US
Mailing Address - Phone:773-552-9859
Mailing Address - Fax:
Practice Address - Street 1:1823 ATTAYA RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2902
Practice Address - Country:US
Practice Address - Phone:773-552-9859
Practice Address - Fax:732-358-2187
Is Sole Proprietor?:No
Enumeration Date:2013-11-28
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist