Provider Demographics
NPI:1235365016
Name:PADDOCK, VANESSA RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LEE CIR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3726
Mailing Address - Country:US
Mailing Address - Phone:610-745-0590
Mailing Address - Fax:
Practice Address - Street 1:212 LEE CIR
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3726
Practice Address - Country:US
Practice Address - Phone:610-745-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist