Provider Demographics
NPI:1225661788
Name:REARDON, CAITLYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:WAJS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1521
Mailing Address - Country:US
Mailing Address - Phone:609-977-9454
Mailing Address - Fax:
Practice Address - Street 1:33 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-1521
Practice Address - Country:US
Practice Address - Phone:609-977-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00895900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty