Provider Demographics
NPI:1003409434
Name:FUENTES, KATHRYN (SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-26 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5634
Mailing Address - Country:US
Mailing Address - Phone:201-509-8205
Mailing Address - Fax:201-857-5766
Practice Address - Street 1:11-26 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5634
Practice Address - Country:US
Practice Address - Phone:201-509-8205
Practice Address - Fax:201-857-5766
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01022700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist