Provider Demographics
NPI:1356642227
Name:MAZZZONE, JOANNA JOAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:JOAN
Last Name:MAZZZONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 NATHANIEL DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5652
Mailing Address - Country:US
Mailing Address - Phone:518-361-1022
Mailing Address - Fax:
Practice Address - Street 1:519 NATHANIEL DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5652
Practice Address - Country:US
Practice Address - Phone:518-361-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004188-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist