Provider Demographics
NPI:1235431479
Name:WARNER, ROXANNE NATALIE (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:NATALIE
Last Name:WARNER
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 1:814 WILLOW AVE
Mailing Address - Street 2:2R
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2925
Mailing Address - Country:US
Mailing Address - Phone:201-798-3306
Mailing Address - Fax:201-798-3306
Practice Address - Street 1:814 WILLOW AVE
Practice Address - Street 2:2R
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2925
Practice Address - Country:US
Practice Address - Phone:201-798-3306
Practice Address - Fax:201-798-3306
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0072771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist