Provider Demographics
NPI:1134446917
Name:MCCUSKER, JENNIFER M (MA CCCSLP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 THACKERY CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1132
Mailing Address - Country:US
Mailing Address - Phone:609-790-5642
Mailing Address - Fax:
Practice Address - Street 1:1111 MARLKRESS RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2334
Practice Address - Country:US
Practice Address - Phone:856-424-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00514100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist