Provider Demographics
NPI:1114497641
Name:WAKSMUNSKI, BREE ANN (MA SLP-CFY)
Entity Type:Individual
Prefix:
First Name:BREE ANN
Middle Name:
Last Name:WAKSMUNSKI
Suffix:
Gender:F
Credentials:MA SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KELLY CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3749
Mailing Address - Country:US
Mailing Address - Phone:609-619-7162
Mailing Address - Fax:
Practice Address - Street 1:292 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3754
Practice Address - Country:US
Practice Address - Phone:609-860-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist