Provider Demographics
NPI:1578785705
Name:CERTNER-SMITH, MARILYN (SLP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:CERTNER-SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:CERTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 NOE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2834
Mailing Address - Country:US
Mailing Address - Phone:973-377-7156
Mailing Address - Fax:973-377-3506
Practice Address - Street 1:427 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3583
Practice Address - Country:US
Practice Address - Phone:973-746-1151
Practice Address - Fax:973-746-1159
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00013500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist