Provider Demographics
NPI:1295017135
Name:GOODMAN, JANNA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:M
Last Name:GOODMAN
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 1:10 DOLPHIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6307
Mailing Address - Country:US
Mailing Address - Phone:845-639-4303
Mailing Address - Fax:
Practice Address - Street 1:1 HEATHER DR
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901-6613
Practice Address - Country:US
Practice Address - Phone:845-357-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014375-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist