Provider Demographics
NPI:1811266240
Name:LOWENTHAL, PHYLLIS PEARL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:PEARL
Last Name:LOWENTHAL
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 1:12 S MOUNTAIN AVE
Mailing Address - Street 2:APT.20
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1750
Mailing Address - Country:US
Mailing Address - Phone:201-247-1582
Mailing Address - Fax:
Practice Address - Street 1:12 S MOUNTAIN AVE
Practice Address - Street 2:APT.20
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1750
Practice Address - Country:US
Practice Address - Phone:201-247-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00058900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist