Provider Demographics
NPI:1104149053
Name:PADOVANO, NANCY L
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:PADOVANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 N BRIDGE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2129
Mailing Address - Country:US
Mailing Address - Phone:908-575-0008
Mailing Address - Fax:
Practice Address - Street 1:475 N BRIDGE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2129
Practice Address - Country:US
Practice Address - Phone:908-575-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01127597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist