Provider Demographics
NPI:1144403635
Name:ANDERSON, GLORIA YOLANDA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:YOLANDA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CAMPUS DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1128
Mailing Address - Country:US
Mailing Address - Phone:732-560-7500
Mailing Address - Fax:732-289-6067
Practice Address - Street 1:370 CAMPUS DR
Practice Address - Street 2:STE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1128
Practice Address - Country:US
Practice Address - Phone:732-560-7500
Practice Address - Fax:732-289-6067
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00388300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist