Provider Demographics
NPI:1376083782
Name:MIRONCHIK, ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MIRONCHIK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 FITZER RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-3901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 FITZER RD
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08825-3901
Practice Address - Country:US
Practice Address - Phone:718-306-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76395-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist