Basic Information
| Provider Information | |||||||||
| NPI: | 1003151010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATALA | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 CATHERINE CT | ||||||||
| Address2: | |||||||||
| City: | SICKLERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080813806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095617550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7 CATHERINE CT | ||||||||
| Address2: | |||||||||
| City: | SICKLERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080813806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095617550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2012 | ||||||||
| LastUpdateDate: | 12/02/2012 | ||||||||
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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 | 41YS00156700 | NJ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.