Provider Demographics
NPI:1356102966
Name:GORELIK, ILANA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:GORELIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2744
Mailing Address - Country:US
Mailing Address - Phone:732-213-9702
Mailing Address - Fax:
Practice Address - Street 1:9 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2744
Practice Address - Country:US
Practice Address - Phone:732-213-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00785500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist