Provider Demographics
NPI:1104502913
Name:TROTTA, MARY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TROTTA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:TROTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3 TETON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:201-316-5438
Mailing Address - Fax:
Practice Address - Street 1:2100 RT. 33, STE.2 REAR
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist