Provider Demographics
NPI:1518219641
Name:JEROME, ALICIA (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:JEROME
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAVERSON BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7869
Mailing Address - Country:US
Mailing Address - Phone:866-557-8669
Mailing Address - Fax:
Practice Address - Street 1:254 BRICK BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7170
Practice Address - Country:US
Practice Address - Phone:732-279-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00609700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00609700OtherNJ STATE LICENSE