Most Relevant Information
Provider Data
| NPI Number: | 1003436452 |
| Provider Name: | KEIRSTIN GLYNN |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/24/2020 |
| Last Updated: | 04/24/2020 |
Provider Practice Location
622 HAWKINS AVE
LAKE RONKONKOMA
NY
117792374
Practice Location Phone/Fax
| Phone: | 6312403579 |
| Fax: |
Provider Mailing Location
6 AVON AVE
PORT JEFFERSON STATION
NY
117763424
Provider Mailing Phone/Fax
| Phone: | 6316171990 |
| Fax: |