Provider Demographics
NPI:1508038365
Name:MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR FINANCE AND TREA
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-655-5105
Mailing Address - Street 1:MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY
Mailing Address - Street 2:1515 BROAD STREET
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-655-3934
Mailing Address - Fax:973-655-7752
Practice Address - Street 1:MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY
Practice Address - Street 2:1515 BROAD STREET
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-655-3934
Practice Address - Fax:973-655-7752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTCLAIR STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty