Provider Demographics
NPI:1689905887
Name:BENSOUSSAN, DYAN ROCHELLE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DYAN
Middle Name:ROCHELLE
Last Name:BENSOUSSAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:DYAN
Other - Middle Name:ROCHELLE
Other - Last Name:BENSOUSSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:15010 71ST AVE
Mailing Address - Street 2:APT. 2B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2143
Mailing Address - Country:US
Mailing Address - Phone:845-270-0108
Mailing Address - Fax:
Practice Address - Street 1:15010 71ST AVE
Practice Address - Street 2:APT. 2B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2143
Practice Address - Country:US
Practice Address - Phone:845-270-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist