Provider Demographics
NPI:1619320108
Name:PAZUELO, LIA (SLP-CF)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:PAZUELO
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARIN BLVD
Mailing Address - Street 2:APT#407
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6491
Mailing Address - Country:US
Mailing Address - Phone:646-321-4351
Mailing Address - Fax:
Practice Address - Street 1:464 RIVERSIDE DR
Practice Address - Street 2:APT 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6822
Practice Address - Country:US
Practice Address - Phone:646-321-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist