Individual
KIMBERLY PAIGE TUCCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 BETHANY RD STE 60, HAZLET, NJ 07730-1667
(732) 888-3912
Mailing address
1 BETHANY RD STE 60, HAZLET, NJ 07730-1667
(732) 888-3912
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00499800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679957997
1679957997
—
Enumeration date
10/30/2019
Last updated
10/30/2019
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