Provider Demographics
NPI:1144559212
Name:PHILLIPS, YESENIA (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:YESENIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 67TH RD APT 1G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2726
Mailing Address - Country:US
Mailing Address - Phone:917-497-6731
Mailing Address - Fax:718-997-7487
Practice Address - Street 1:10240 67TH DR
Practice Address - Street 2:SUITE C2
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2800
Practice Address - Country:US
Practice Address - Phone:917-497-6731
Practice Address - Fax:718-997-0341
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016110-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist