Healthcare Provider Details

I. General information

NPI: 1639659311
Provider Name (Legal Business Name): GARDEN STATE AAC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CHURCH STREET SUITE 119
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

11 HIGHFIELDS RD.
CLINTON NJ
08809
US

V. Phone/Fax

Practice location:
  • Phone: 908-652-4403
  • Fax:
Mailing address:
  • Phone: 908-652-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00658500
License Number StateNJ

VIII. Authorized Official

Name: MELISSA DONOVAN
Title or Position: OWNER, SLP, ATP
Credential: M.S. CCC-SLP, ATP
Phone: 914-498-2549