Provider Demographics
NPI:1649662842
Name:CZERMAK, LEAH (MS SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CZERMAK
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 5TH ST
Mailing Address - Street 2:APT C2
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2506
Mailing Address - Country:US
Mailing Address - Phone:732-901-4362
Mailing Address - Fax:
Practice Address - Street 1:1074 TIMES SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5524
Practice Address - Country:US
Practice Address - Phone:732-363-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-2510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist