Provider Demographics
NPI:1558180075
Name:EXPRESS IT SPEECH-LANGUAGE PATHOLOGISTS
Entity type:Organization
Organization Name:EXPRESS IT SPEECH-LANGUAGE PATHOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-288-6825
Mailing Address - Street 1:218 COMMONS WAY BLDG B
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6427
Mailing Address - Country:US
Mailing Address - Phone:732-829-3047
Mailing Address - Fax:
Practice Address - Street 1:218 COMMONS WAY BLDG B
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6427
Practice Address - Country:US
Practice Address - Phone:732-829-3047
Practice Address - Fax:732-608-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech