Provider Demographics
NPI:1326634668
Name:MINKIEWICZ, EVETTE (SLP)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:
Last Name:MINKIEWICZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WHITE ROCK RD APT 3203
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1526
Mailing Address - Country:US
Mailing Address - Phone:201-245-4457
Mailing Address - Fax:
Practice Address - Street 1:110 WHITE ROCK RD APT 3203
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1526
Practice Address - Country:US
Practice Address - Phone:201-245-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01058300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist