Provider Demographics
NPI:1770357568
Name:BECKER, SHOSHANA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300A SAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3564
Mailing Address - Country:US
Mailing Address - Phone:516-666-0435
Mailing Address - Fax:
Practice Address - Street 1:60 PARK AVE S
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3554
Practice Address - Country:US
Practice Address - Phone:516-666-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist