Provider Demographics
NPI:1053740027
Name:FRENKEL, KELLY (MS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FRENKEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 AVENUE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2949
Mailing Address - Country:US
Mailing Address - Phone:718-339-2464
Mailing Address - Fax:
Practice Address - Street 1:415 AVENUE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2949
Practice Address - Country:US
Practice Address - Phone:718-339-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist