Provider Demographics
NPI:1902949498
Name:BOSHNACK, ARLENE JOAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:JOAN
Last Name:BOSHNACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAW MILL LN
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2308
Mailing Address - Country:US
Mailing Address - Phone:631-692-9820
Mailing Address - Fax:631-692-9821
Practice Address - Street 1:5 SAW MILL LN
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2308
Practice Address - Country:US
Practice Address - Phone:631-692-9820
Practice Address - Fax:631-692-9821
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004342-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist