Provider Demographics
NPI:1679253546
Name:SHMUSHKOVICH, ROCHELL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROCHELL
Middle Name:
Last Name:SHMUSHKOVICH
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 1:16 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9316
Mailing Address - Country:US
Mailing Address - Phone:646-541-9174
Mailing Address - Fax:
Practice Address - Street 1:16 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9316
Practice Address - Country:US
Practice Address - Phone:646-541-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01202700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist