Healthcare Provider Details

I. General information

NPI: 1093628950
Provider Name (Legal Business Name): THERESA TAWIL M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E PASSAIC AVE
BLOOMFIELD NJ
07003-3752
US

IV. Provider business mailing address

135 E PASSAIC AVE
BLOOMFIELD NJ
07003-3752
US

V. Phone/Fax

Practice location:
  • Phone: 973-931-7756
  • Fax:
Mailing address:
  • Phone: 973-931-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01142500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: