Provider Demographics
NPI:1831302629
Name:FORNARO, SUZANNE M (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:FORNARO
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 1:15 BEAR CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1300
Mailing Address - Country:US
Mailing Address - Phone:609-585-3722
Mailing Address - Fax:609-585-3793
Practice Address - Street 1:15 BEAR CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-1300
Practice Address - Country:US
Practice Address - Phone:609-585-3722
Practice Address - Fax:609-585-3793
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00154100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist