Provider Demographics
NPI:1417423534
Name:INGRAM, JANET (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:INGRAM
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 1:875 ELM ST APT 213
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2122
Mailing Address - Country:US
Mailing Address - Phone:631-793-3264
Mailing Address - Fax:
Practice Address - Street 1:195 MCGREGOR ST STE 400
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3779
Practice Address - Country:US
Practice Address - Phone:603-206-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0736235Z00000X
NH1918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist