Healthcare Provider Details

I. General information

NPI: 1831004753
Provider Name (Legal Business Name): KATHERINE DELANEY POLOS M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 MAIN AVE
CLIFTON NJ
07011-2333
US

IV. Provider business mailing address

150 LINDEN DR
BASKING RIDGE NJ
07920-1965
US

V. Phone/Fax

Practice location:
  • Phone: 201-344-2499
  • Fax:
Mailing address:
  • Phone: 908-255-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01406900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: