Provider Demographics
NPI:1730326000
Name:TENDLER, IRENE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:TENDLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 LINDSEY HOUSE APT 4
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4517
Mailing Address - Country:US
Mailing Address - Phone:518-456-2716
Mailing Address - Fax:
Practice Address - Street 1:6211 LINDSEY HOUSE
Practice Address - Street 2:#4
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-456-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002109-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 5255OtherSPEECH PATHOLOGIST
MA3433OtherSPEECH PATHOLOGIST