Provider Demographics
NPI:1649603630
Name:SULTAN - MAIMON, JUNE K (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:K
Last Name:SULTAN - MAIMON
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 1:255 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1314
Mailing Address - Country:US
Mailing Address - Phone:732-299-9049
Mailing Address - Fax:
Practice Address - Street 1:255 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1314
Practice Address - Country:US
Practice Address - Phone:732-299-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ41YS00798700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program