Provider Demographics
NPI:1568736700
Name:OCEAN SPEECH AND LEARNING CENTER
Entity Type:Organization
Organization Name:OCEAN SPEECH AND LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DI STEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:732-237-8830
Mailing Address - Street 1:1 PELICAN DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1600
Mailing Address - Country:US
Mailing Address - Phone:732-237-8830
Mailing Address - Fax:732-237-8836
Practice Address - Street 1:1 PELICAN DR
Practice Address - Street 2:SUITE 9
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1600
Practice Address - Country:US
Practice Address - Phone:732-237-8830
Practice Address - Fax:732-237-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00418400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty