Provider Demographics
NPI:1679871719
Name:PONIK, NOREEN H (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:H
Last Name:PONIK
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 1:6 ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1307
Mailing Address - Country:US
Mailing Address - Phone:732-382-9050
Mailing Address - Fax:
Practice Address - Street 1:6 ABBEY CT
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1307
Practice Address - Country:US
Practice Address - Phone:732-382-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2023-01-24
Deactivation Date:2012-01-06
Deactivation Code:
Reactivation Date:2023-01-24
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00638800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist