Provider Demographics
NPI:1124905963
Name:KREISMANN, MIRIAM (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KREISMANN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1107
Mailing Address - Country:US
Mailing Address - Phone:845-642-6464
Mailing Address - Fax:
Practice Address - Street 1:7 LAURA LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1107
Practice Address - Country:US
Practice Address - Phone:845-642-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00698600235Z00000X
NY024392-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist