Provider Demographics
NPI:1821200668
Name:LA SALLE, MONICA THERESE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:THERESE
Last Name:LA SALLE
Suffix:
Gender:F
Credentials:MA CCC SLP
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Other - First Name:
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Mailing Address - Street 1:509 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5842
Mailing Address - Country:US
Mailing Address - Phone:609-435-3067
Mailing Address - Fax:609-854-3190
Practice Address - Street 1:509 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-5842
Practice Address - Country:US
Practice Address - Phone:215-694-0689
Practice Address - Fax:215-632-7406
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASL004452L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist