Provider Demographics
NPI:1346555745
Name:PENDERGAST, SUZANNE (MS, SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PENDERGAST
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8317
Mailing Address - Country:US
Mailing Address - Phone:201-376-5931
Mailing Address - Fax:201-505-1091
Practice Address - Street 1:27 PASCACK RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8317
Practice Address - Country:US
Practice Address - Phone:201-376-5931
Practice Address - Fax:201-505-1091
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist