Provider Demographics
NPI:1861721508
Name:GLATT, RIVKA L (MS-SLP)
Entity type:Individual
Prefix:
First Name:RIVKA
Middle Name:L
Last Name:GLATT
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:RIVKA
Other - Middle Name:L
Other - Last Name:WACHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-SLP
Mailing Address - Street 1:14438 75TH RD
Mailing Address - Street 2:APT 1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2400
Mailing Address - Country:US
Mailing Address - Phone:347-239-9671
Mailing Address - Fax:
Practice Address - Street 1:14438 75TH RD
Practice Address - Street 2:APT 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2400
Practice Address - Country:US
Practice Address - Phone:347-239-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist