Individual
STACY OTTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
53 AVENUE K, MONROE, NJ 08831-2138
(732) 561-2123
Mailing address
53 AVENUE K, MONROE, NJ 08831-2138
(732) 561-2123
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
008832-1
NY
235Z00000X
Speech-Language Pathologist
Primary
41YS00558100
NJ
Other
Enumeration date
02/09/2009
Last updated
02/09/2009
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