Provider Demographics
NPI:1477782951
Name:PEDINOFF, CARA SUSAN (M A, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:SUSAN
Last Name:PEDINOFF
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 BLANCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1304
Mailing Address - Country:US
Mailing Address - Phone:732-241-9069
Mailing Address - Fax:
Practice Address - Street 1:608 BLANCHARD PKWY
Practice Address - Street 2:
Practice Address - City:WEST ALLENHURST
Practice Address - State:NJ
Practice Address - Zip Code:07711-1304
Practice Address - Country:US
Practice Address - Phone:732-241-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00052300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist