Basic Information
| Provider Information | |||||||||
| NPI: | 1003140633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 MORRIS AVE | ||||||||
| Address2: | |||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087363521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322235756 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 57 MORRIS AVE | ||||||||
| Address2: | |||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087363521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322235756 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 41YS00219500 | NJ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.