Provider Demographics
NPI:1457178352
Name:SARGENTI, NICOLE MARIE (SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SARGENTI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CAROLYN CT
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1365
Mailing Address - Country:US
Mailing Address - Phone:551-427-9773
Mailing Address - Fax:
Practice Address - Street 1:44 APPLE ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2671
Practice Address - Country:US
Practice Address - Phone:551-427-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01199000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist