Healthcare Provider Details

I. General information

NPI: 1235057472
Provider Name (Legal Business Name): PEYTON GRACE QUACKENBUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 UNION AVE
BRIDGEWATER NJ
08807-3108
US

IV. Provider business mailing address

207 BROKAW CT
HILLSBOROUGH NJ
08844-3418
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-2366
  • Fax:
Mailing address:
  • Phone: 908-304-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01399400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: