MEDICARE: MRS. YEHUDIS JUTCOVICH M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00780000	NJ

General Provider Information

NPI Number	:	1619382272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YEHUDIS JUTCOVICH M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1414 TOWERS ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5447
Country	:	US
Telephone Number	:	908-907-0550
Fax Number	:	732-905-6525

Provider Business Practice Location Address
First Line	:	1414 TOWERS ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5447
Country	:	US
Telephone Number	:	908-807-0550
Fax Number	:	732-905-6525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	10/16/2025

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