Provider Demographics
NPI:1417359506
Name:HARDJONO, FLORENCE (PHD-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:
Last Name:HARDJONO
Suffix:
Gender:F
Credentials:PHD-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 LAUREL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8093
Mailing Address - Country:US
Mailing Address - Phone:614-459-2429
Mailing Address - Fax:
Practice Address - Street 1:3769 ATTUCKS DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6080
Practice Address - Country:US
Practice Address - Phone:614-467-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2015098-SP235Z00000X
OHSP12384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist