Provider Demographics
NPI:1215198767
Name:STUART, JANE HADDAD (MA, CCC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:HADDAD
Last Name:STUART
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC
Mailing Address - Street 1:217 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:KINTNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18930-9764
Mailing Address - Country:US
Mailing Address - Phone:562-208-5048
Mailing Address - Fax:610-847-2989
Practice Address - Street 1:190 PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3153
Practice Address - Country:US
Practice Address - Phone:562-439-6244
Practice Address - Fax:562-438-6244
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 9815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist