Provider Demographics
NPI:1811323041
Name:HETLINGER, MARIA TAFFONI (AU D)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TAFFONI
Last Name:HETLINGER
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 TAVISTOCK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9259
Mailing Address - Country:US
Mailing Address - Phone:609-346-5391
Mailing Address - Fax:
Practice Address - Street 1:200 ARBOR LAKE DR STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4516
Practice Address - Country:US
Practice Address - Phone:803-457-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00063200231H00000X
NJ25MG00098800231H00000X
PAAT005811231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist