Provider Demographics
NPI:1639795040
Name:CIALLELLA, ERINMARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERINMARIE
Middle Name:
Last Name:CIALLELLA
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 1:212 SPIRIT WAY
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-3526
Mailing Address - Country:US
Mailing Address - Phone:732-735-4027
Mailing Address - Fax:
Practice Address - Street 1:212 SPIRIT WAY
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-3526
Practice Address - Country:US
Practice Address - Phone:732-735-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00897900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist