Provider Demographics
NPI:1639646615
Name:TREUER, MARY CAROLYN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CAROLYN
Last Name:TREUER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:CAROLYN
Other - Last Name:TREUER DEL OJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:91 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2858
Mailing Address - Country:US
Mailing Address - Phone:973-960-8520
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST STE 528
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1621
Practice Address - Country:US
Practice Address - Phone:973-535-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS000903200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty