Healthcare Provider Details

I. General information

NPI: 1710699202
Provider Name (Legal Business Name): FUNCTIONAL SPEECH AND LANGUAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CAYUGA RD
CRANFORD NJ
07016-3455
US

IV. Provider business mailing address

32 CAYUGA RD
CRANFORD NJ
07016-3455
US

V. Phone/Fax

Practice location:
  • Phone: 908-227-4934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA KUKIS
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 908-227-4934