Provider Demographics
NPI:1063632354
Name:VANDERVLIET, CORNELIA (MA,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:
Last Name:VANDERVLIET
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHANDA CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1936
Mailing Address - Country:US
Mailing Address - Phone:973-365-0381
Mailing Address - Fax:
Practice Address - Street 1:140 BERGEN ST
Practice Address - Street 2:LEVEL E ROOM 1700
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-9500
Practice Address - Fax:973-972-3923
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00004900231H00000X
NJ25MG00045400237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist