Provider Demographics
NPI:1043864713
Name:STILWELL, SHAYLYN MAREE (MS ED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHAYLYN
Middle Name:MAREE
Last Name:STILWELL
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BLDG 5 STE 60
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1667
Mailing Address - Country:US
Mailing Address - Phone:732-888-3912
Mailing Address - Fax:732-888-3916
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BLDG 5 STE 60
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1667
Practice Address - Country:US
Practice Address - Phone:732-888-3912
Practice Address - Fax:732-888-3916
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00942400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679957997OtherGROUP NPI