Provider Demographics
NPI:1053026161
Name:KELCZEWSKI, DYLAN (SLP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:KELCZEWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:
Other - Last Name:ROSENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:973-584-3192
Mailing Address - Fax:
Practice Address - Street 1:85 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1970
Practice Address - Country:US
Practice Address - Phone:201-639-8870
Practice Address - Fax:201-639-8874
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist