Provider Demographics
NPI:1437735032
Name:LEVINE, INESSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:LEVINE
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 1:416 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2715
Mailing Address - Country:US
Mailing Address - Phone:609-902-9479
Mailing Address - Fax:
Practice Address - Street 1:2560 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-3480
Practice Address - Country:US
Practice Address - Phone:609-438-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00386500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty