Provider Demographics
NPI:1639336563
Name:BLUMSTEIN, PENNY JO (MS CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:JO
Last Name:BLUMSTEIN
Suffix:
Gender:F
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STANLEY PL
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2324
Mailing Address - Country:US
Mailing Address - Phone:732-494-5755
Mailing Address - Fax:
Practice Address - Street 1:9 STANLEY PL
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2324
Practice Address - Country:US
Practice Address - Phone:732-494-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00093000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist