Provider Demographics
NPI:1487961488
Name:PELLAGRINI, LINDA (MSPA, CCC-SP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PELLAGRINI
Suffix:
Gender:F
Credentials:MSPA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 5TH ST
Mailing Address - Street 2:503
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3157
Mailing Address - Country:US
Mailing Address - Phone:718-782-8446
Mailing Address - Fax:
Practice Address - Street 1:277 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1003
Practice Address - Country:US
Practice Address - Phone:718-499-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009982-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist