Provider Demographics
NPI:1871702126
Name:CONSTANTARAKOS, VOULA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:VOULA
Middle Name:
Last Name:CONSTANTARAKOS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:PROF
Other - First Name:PREMIER
Other - Middle Name:
Other - Last Name:SPEECH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:57 BRIDGEWATERS DR
Mailing Address - Street 2:1
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:72
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-208-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00414600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist