Provider Demographics
NPI:1114209038
Name:DEOSSA, JOANNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:
Last Name:DEOSSA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALDRICH STREET
Mailing Address - Street 2:APT 15C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4516
Mailing Address - Country:US
Mailing Address - Phone:917-450-3755
Mailing Address - Fax:
Practice Address - Street 1:920 E 167TH ST # CS150
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2317
Practice Address - Country:US
Practice Address - Phone:718-328-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020679-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist