Provider Demographics
NPI:1912785692
Name:SERKEZ, SHOSHANA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:SERKEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:LIEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:419 DR M L KING DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4848
Mailing Address - Country:US
Mailing Address - Phone:443-726-0941
Mailing Address - Fax:
Practice Address - Street 1:419 DR M L KING DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4848
Practice Address - Country:US
Practice Address - Phone:443-726-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist