Provider Demographics
NPI:1760828115
Name:SCANLON, KIMBERLY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SCANLON
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 1:10 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2715
Mailing Address - Country:US
Mailing Address - Phone:201-874-8951
Mailing Address - Fax:
Practice Address - Street 1:17 S FRANKLIN TPKE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2552
Practice Address - Country:US
Practice Address - Phone:201-874-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00582600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist