Provider Demographics
NPI:1871137752
Name:D'AGOSTINO, DESIREE M (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:M
Last Name:D'AGOSTINO
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 1:13 STONEHENGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2614
Mailing Address - Country:US
Mailing Address - Phone:862-621-9390
Mailing Address - Fax:
Practice Address - Street 1:13 STONEHENGE RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2614
Practice Address - Country:US
Practice Address - Phone:862-621-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00933700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist