Provider Demographics
NPI:1548000714
Name:FISHBANE, NECHAMA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:NECHAMA
Middle Name:
Last Name:FISHBANE
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:NECHAMA
Other - Middle Name:
Other - Last Name:SOROKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:2502 LAURELHURST RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4612
Mailing Address - Country:US
Mailing Address - Phone:347-429-2860
Mailing Address - Fax:
Practice Address - Street 1:2502 LAURELHURST RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4612
Practice Address - Country:US
Practice Address - Phone:347-429-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist