Provider Demographics
NPI:1336399575
Name:YU, KATHLEEN J (AUD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:YU
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATHLEE
Other - Middle Name:J
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23861
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0861
Mailing Address - Country:US
Mailing Address - Phone:201-692-0500
Mailing Address - Fax:201-836-7838
Practice Address - Street 1:13-19 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1837
Practice Address - Country:US
Practice Address - Phone:201-703-6800
Practice Address - Fax:201-703-6805
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00048200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist