Provider Demographics
NPI:1366090524
Name:MYSZKO, VICTORIA (TSSLD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MYSZKO
Suffix:
Gender:F
Credentials:TSSLD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155A AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5137
Mailing Address - Country:US
Mailing Address - Phone:718-302-1676
Mailing Address - Fax:
Practice Address - Street 1:545 WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6815
Practice Address - Country:US
Practice Address - Phone:718-387-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty