Organization
SLLCCNINC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ANN BLACK MA CCC-SLP (CO-DIRECTOR)
(732) 761-0005
Entity
Organization
Contact information
Practice address
281 ROUTE 34 STE 807, COLTS NECK, NJ 07722-2440
(732) 761-0005
(732) 761-0075
Mailing address
281 ROUTE 34 STE 807, COLTS NECK, NJ 07722-2440
(732) 761-0005
(732) 761-0075
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00271800
NJ
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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