Provider Demographics
NPI:1457478893
Name:WU, JAMES I (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:WU
Suffix:I
Gender:M
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 1:17501 PECK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1129
Mailing Address - Country:US
Mailing Address - Phone:917-771-5242
Mailing Address - Fax:
Practice Address - Street 1:17501 PECK AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1129
Practice Address - Country:US
Practice Address - Phone:917-771-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009922-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist