Provider Demographics
NPI:1205962354
Name:STAUBER, MERRILL SUE (MACCC)
Entity type:Individual
Prefix:MRS
First Name:MERRILL
Middle Name:SUE
Last Name:STAUBER
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 TAYLOR MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3255
Mailing Address - Country:US
Mailing Address - Phone:732-431-5093
Mailing Address - Fax:732-431-5094
Practice Address - Street 1:219 TAYLOR MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3255
Practice Address - Country:US
Practice Address - Phone:732-431-5093
Practice Address - Fax:732-431-5094
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00180400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist