Provider Demographics
NPI:1295092757
Name:SOCHACZEWSKI, NAOMI ANNE (MS, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:ANNE
Last Name:SOCHACZEWSKI
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 1:11 SHILO RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5235
Mailing Address - Country:US
Mailing Address - Phone:732-364-3401
Mailing Address - Fax:
Practice Address - Street 1:1509 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3918
Practice Address - Country:US
Practice Address - Phone:732-364-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00685500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist