Provider Demographics
NPI:1689916769
Name:BALEWICZ, LYNN M (LICENSE)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:BALEWICZ
Suffix:
Gender:F
Credentials:LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1252
Mailing Address - Country:US
Mailing Address - Phone:732-501-5643
Mailing Address - Fax:
Practice Address - Street 1:18 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1252
Practice Address - Country:US
Practice Address - Phone:732-501-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00021100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist