Provider Demographics
NPI:1144386871
Name:BANIK, JANET MARY (MS, CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARY
Last Name:BANIK
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WILDER RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1258
Mailing Address - Country:US
Mailing Address - Phone:857-205-6968
Mailing Address - Fax:
Practice Address - Street 1:119 WILDER RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1258
Practice Address - Country:US
Practice Address - Phone:857-205-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist