Individual
KATHERINE PROVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1333 DOMINIC ST, MANVILLE, NJ 08835-1956
(973) 216-0689
Mailing address
1333 DOMINIC ST, MANVILLE, NJ 08835-1956
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00699600
NJ
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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