Provider Demographics
NPI:1942565726
Name:LUKE, REZIA (SLP-CCC/ TSSLD)
Entity type:Individual
Prefix:MS
First Name:REZIA
Middle Name:
Last Name:LUKE
Suffix:
Gender:F
Credentials:SLP-CCC/ TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30387
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-0387
Mailing Address - Country:US
Mailing Address - Phone:718-913-3494
Mailing Address - Fax:
Practice Address - Street 1:495 FLATBUSH AVE STE 21
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:877-585-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600142121235500000X
NY023370-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist