Provider Demographics
NPI:1447415898
Name:WONG, JANELLE ALLISON (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:ALLISON
Last Name:WONG
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 1:21 SAMOSET AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RHODE ISLAND
Mailing Address - Zip Code:02806
Mailing Address - Country:UM
Mailing Address - Phone:917-805-6853
Mailing Address - Fax:
Practice Address - Street 1:21 SAMOSET AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3124
Practice Address - Country:US
Practice Address - Phone:917-805-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist