Provider Demographics
NPI:1518589241
Name:BUCKLEY, PATRICIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 3RD ST APT E2
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2764
Mailing Address - Country:US
Mailing Address - Phone:845-341-3263
Mailing Address - Fax:
Practice Address - Street 1:38 RIVER EDGE RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2442
Practice Address - Country:US
Practice Address - Phone:201-843-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00776000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist