Provider Demographics
NPI:1629359641
Name:LEPELSTAT, ANITA RAYNES (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:RAYNES
Last Name:LEPELSTAT
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 1:96 ENCLAVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5783
Mailing Address - Country:US
Mailing Address - Phone:732-886-3638
Mailing Address - Fax:
Practice Address - Street 1:96 ENCLAVE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5783
Practice Address - Country:US
Practice Address - Phone:732-886-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00165400235Z00000X
NJ235Z000000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist