Provider Demographics
NPI:1457666240
Name:IANNOTTA, JUDITH A (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:IANNOTTA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4206
Mailing Address - Country:US
Mailing Address - Phone:516-783-8835
Mailing Address - Fax:
Practice Address - Street 1:2356 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4206
Practice Address - Country:US
Practice Address - Phone:516-783-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist