Provider Demographics
NPI:1801376835
Name:ODEJAR, MARIE A (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:ODEJAR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1166
Mailing Address - Country:US
Mailing Address - Phone:732-589-9406
Mailing Address - Fax:
Practice Address - Street 1:1208 STATE ROUTE 34 UNIT A
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1940
Practice Address - Country:US
Practice Address - Phone:732-705-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00927600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist