Provider Demographics
NPI:1104004977
Name:TANCREDI, PATRICIA (MA-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:TANCREDI
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27A BRANDYWYNE
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1323
Mailing Address - Country:US
Mailing Address - Phone:609-290-5658
Mailing Address - Fax:
Practice Address - Street 1:27A BRANDYWYNE
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1323
Practice Address - Country:US
Practice Address - Phone:609-290-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00246800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist