Provider Demographics
NPI:1003012543
Name:FROST, JOAN M (SLP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:FROST
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ANCHOR RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-8829
Mailing Address - Country:US
Mailing Address - Phone:815-288-6691
Mailing Address - Fax:815-288-1636
Practice Address - Street 1:500 ANCHOR RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-8829
Practice Address - Country:US
Practice Address - Phone:815-288-6691
Practice Address - Fax:815-288-1636
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist