Provider Demographics
NPI:1831883867
Name:GUGENHEIMER, RIVKA (CF)
Entity type:Individual
Prefix:MRS
First Name:RIVKA
Middle Name:
Last Name:GUGENHEIMER
Suffix:
Gender:F
Credentials:CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 7TH ST UNIT 219
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3771
Mailing Address - Country:US
Mailing Address - Phone:848-223-3363
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:732-595-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist