Provider Demographics
NPI:1548512106
Name:BYWALSKI, ANNICK GENEVIEVE (ANNICK BYWALSKI)
Entity type:Individual
Prefix:MRS
First Name:ANNICK
Middle Name:GENEVIEVE
Last Name:BYWALSKI
Suffix:
Gender:F
Credentials:ANNICK BYWALSKI
Other - Prefix:
Other - First Name:ANNICK
Other - Middle Name:GENEVIEVE
Other - Last Name:BYWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANNICK BYWALSKI TEAC
Mailing Address - Street 1:2323 AVE V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:347-371-9209
Mailing Address - Fax:
Practice Address - Street 1:2323 AVENUE V
Practice Address - Street 2:2323 AVE V
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4907
Practice Address - Country:US
Practice Address - Phone:347-371-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
NY235200000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant