Provider Demographics
NPI:1427472158
Name:HARPER, MAUREEN SUSAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SUSAN
Last Name:HARPER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1920
Mailing Address - Country:US
Mailing Address - Phone:317-517-7075
Mailing Address - Fax:
Practice Address - Street 1:63 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1920
Practice Address - Country:US
Practice Address - Phone:317-517-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00759300235Z00000X
NY023274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist