Provider Demographics
NPI:1639910888
Name:HACKER, EMILY JORDAN (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JORDAN
Last Name:HACKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ROBERTSON WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1856
Mailing Address - Country:US
Mailing Address - Phone:973-747-7865
Mailing Address - Fax:
Practice Address - Street 1:155 PASSAIC AVE STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3562
Practice Address - Country:US
Practice Address - Phone:973-800-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01263000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist