Provider Demographics
NPI:1083004428
Name:CHINIGO, KERRY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:CHINIGO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BOGERT RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1861
Mailing Address - Country:US
Mailing Address - Phone:201-956-3644
Mailing Address - Fax:
Practice Address - Street 1:223 OLD HOOK RD STE 2
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3132
Practice Address - Country:US
Practice Address - Phone:201-956-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00750500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist