Individual
KAITLYN SHAY BAZERQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
132 CRUISE RD, MANAHAWKIN, NJ 08050-1223
(609) 549-2177
Mailing address
42 NEWELL AVE, WEST CREEK, NJ 08092-9608
(609) 661-0745
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00988300
NJ
Other
Enumeration date
05/04/2023
Last updated
10/11/2023
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