Provider Demographics
NPI:1053322446
Name:CRONK, REBECCA ALISON (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALISON
Last Name:CRONK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ALISON
Other - Last Name:STARKAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ALTANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1976
Mailing Address - Country:US
Mailing Address - Phone:201-291-0550
Mailing Address - Fax:
Practice Address - Street 1:250 BROOKMERE COURT
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-291-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00034100231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7121202Medicaid
NJ7121202Medicaid