Provider Demographics
NPI:1316413396
Name:NESTERWITZ, REBECCA GRACE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:GRACE
Last Name:NESTERWITZ
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WASHINGTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2517
Mailing Address - Country:US
Mailing Address - Phone:732-966-7973
Mailing Address - Fax:
Practice Address - Street 1:15 DELLWOOD LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1551
Practice Address - Country:US
Practice Address - Phone:732-545-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00955400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist