Individual
MRS. AMIE C GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
150 NEW PROVIDENCE RD, MOUNTAINSIDE, NJ 07092-2590
(908) 233-3720
Mailing address
28 GLEN OAKS CT, OLD BRIDGE, NJ 08857-3503
(732) 313-6451
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00370700
NJ
Other
Enumeration date
07/24/2007
Last updated
07/24/2007
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