Provider Demographics
NPI:1083788657
Name:UDZIELA, JOAN (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:UDZIELA
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11097 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1509
Mailing Address - Country:US
Mailing Address - Phone:314-213-8100
Mailing Address - Fax:314-213-8610
Practice Address - Street 1:11097 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1509
Practice Address - Country:US
Practice Address - Phone:314-213-8100
Practice Address - Fax:314-213-8610
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist