Provider Demographics
NPI:1689210478
Name:DUBLIN, THERESE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:DUBLIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1327
Mailing Address - Country:US
Mailing Address - Phone:973-960-2649
Mailing Address - Fax:
Practice Address - Street 1:237 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3714
Practice Address - Country:US
Practice Address - Phone:973-960-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty