Provider Demographics
NPI:1699002154
Name:KOLODNY, MIRIAM (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:KOLODNY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5402
Mailing Address - Country:US
Mailing Address - Phone:848-525-2081
Mailing Address - Fax:732-377-5484
Practice Address - Street 1:130 LEONARD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2049
Practice Address - Country:US
Practice Address - Phone:732-905-0725
Practice Address - Fax:732-377-5484
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00606900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist