Provider Demographics
NPI:1316482797
Name:BROOKS-BONDER, JUDY MARLA (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:MARLA
Last Name:BROOKS-BONDER
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 1:19 CONSTITUTION CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3437
Mailing Address - Country:US
Mailing Address - Phone:732-580-4030
Mailing Address - Fax:732-432-7612
Practice Address - Street 1:19 CONSTITUTION CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-580-4030
Practice Address - Fax:732-432-7612
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021089-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist