Provider Demographics
NPI:1760702773
Name:COHEN, HEATHER MELISSA (AUD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MELISSA
Last Name:COHEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MELISSA
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:714 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2921
Mailing Address - Country:US
Mailing Address - Phone:201-863-3346
Mailing Address - Fax:201-863-5251
Practice Address - Street 1:714 10TH ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2921
Practice Address - Country:US
Practice Address - Phone:201-863-3346
Practice Address - Fax:201-863-5251
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231H00000X
NJ41YA00087400231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist