Provider Demographics
NPI:1942507926
Name:SPALLANZANI, MARY COLLEEN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:COLLEEN
Last Name:SPALLANZANI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:COLLEEN
Other - Last Name:DUNICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 DAVID BRAINERD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1927
Mailing Address - Country:US
Mailing Address - Phone:732-521-6663
Mailing Address - Fax:
Practice Address - Street 1:1 DAVID BRAINERD DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1927
Practice Address - Country:US
Practice Address - Phone:732-521-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00654200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist