Doctor Name: | MR. PETER O'DOUGHERTY |
NPI Number: | 1790800019 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S., CCC-SLP |
License Number: | 41YS00516800 |
Business Practice Address: | 1515 Lamberts Mill Rd Westfield, NJ - 070904763 |
Business Phone Number: | 9083018259 |
Business Fax Number: | |
Mailing Address: | 253 Wood Ave, STATEN ISLAND |
State: | NY |
Postal Code: | 103071350 |
Phone Number: | 9178347412 |
Fax Number: | |
NPI Enumeration Date: | 03/20/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 41YS00516800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |