Provider Demographics
NPI:1043570278
Name:DELP, JUSTINE AMANDA
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:AMANDA
Last Name:DELP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-9792
Mailing Address - Country:US
Mailing Address - Phone:570-966-2845
Mailing Address - Fax:570-966-6393
Practice Address - Street 1:14 S 11TH ST
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-9792
Practice Address - Country:US
Practice Address - Phone:570-966-2845
Practice Address - Fax:570-966-6393
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist