Provider Demographics
NPI:1851631188
Name:FOSSETTA, NANCY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FOSSETTA
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 1:4257 ROUTE 9 N
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8310
Mailing Address - Country:US
Mailing Address - Phone:732-303-9660
Mailing Address - Fax:732-303-1810
Practice Address - Street 1:4257 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8310
Practice Address - Country:US
Practice Address - Phone:732-303-9660
Practice Address - Fax:732-303-1810
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00233900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist