Provider Demographics
NPI:1619382272
Name:JUTCOVICH, YEHUDIS (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YEHUDIS
Middle Name:
Last Name:JUTCOVICH
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 1:1414 TOWERS ST.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5259
Mailing Address - Country:US
Mailing Address - Phone:908-807-0550
Mailing Address - Fax:732-905-6525
Practice Address - Street 1:1414 TOWERS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5447
Practice Address - Country:US
Practice Address - Phone:908-807-0550
Practice Address - Fax:732-905-6525
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00780000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist