Provider Demographics
NPI:1093579013
Name:EUKSUZIAN, COLETTE (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:EUKSUZIAN
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 SUFFOLK PL
Mailing Address - Street 2:
Mailing Address - City:HARVEY CEDARS
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5880
Mailing Address - Country:US
Mailing Address - Phone:856-298-8449
Mailing Address - Fax:
Practice Address - Street 1:1064 S MAIN ST BLDG 2C
Practice Address - Street 2:
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092-2914
Practice Address - Country:US
Practice Address - Phone:609-488-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist