Provider Demographics
NPI:1548551088
Name:BUCKLEY, JUSTINE ELIZABETH (MSED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ELIZABETH
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FARNSWORTH DR
Mailing Address - Street 2:APT. #17
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9768
Mailing Address - Country:US
Mailing Address - Phone:518-569-6172
Mailing Address - Fax:
Practice Address - Street 1:2841 THOUSAND ACRES RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-1917
Practice Address - Country:US
Practice Address - Phone:518-875-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020923-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist