Provider Demographics
NPI:1598884710
Name:PEDINOFF, ALLISON TRACY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:TRACY
Last Name:PEDINOFF
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MADISON AVE
Mailing Address - Street 2:APT. 14C
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1453
Mailing Address - Country:US
Mailing Address - Phone:973-715-3658
Mailing Address - Fax:
Practice Address - Street 1:84 COLD HILL RD
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-2021
Practice Address - Country:US
Practice Address - Phone:973-543-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00489900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist