Provider Demographics
NPI:1528258993
Name:WUNDERLICH, NANCY (MS,CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ATLANTA CT UNIT 8
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3604
Mailing Address - Country:US
Mailing Address - Phone:732-673-9262
Mailing Address - Fax:
Practice Address - Street 1:6989 ROUTE 18
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3345
Practice Address - Country:US
Practice Address - Phone:732-360-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00405200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist