Provider Demographics
NPI:1275927287
Name:ZOTTARELLI, STEPHANIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ZOTTARELLI
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 1:201 S MAIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-1800
Mailing Address - Country:US
Mailing Address - Phone:609-397-7200
Mailing Address - Fax:609-397-3278
Practice Address - Street 1:201 S MAIN ST BLDG A
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-1800
Practice Address - Country:US
Practice Address - Phone:609-397-7200
Practice Address - Fax:609-397-3278
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00821000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist