Provider Demographics
NPI:1467594556
Name:ENNS, JOAN Y (M A)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:Y
Last Name:ENNS
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 CAMINO VERDE DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1401
Mailing Address - Country:US
Mailing Address - Phone:408-229-7030
Mailing Address - Fax:408-229-7033
Practice Address - Street 1:6140 CAMINO VERDE DR
Practice Address - Street 2:SUITE K
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1401
Practice Address - Country:US
Practice Address - Phone:408-229-7030
Practice Address - Fax:408-229-7033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0032830Medicaid
CACPG086900OtherCALIFORNIA CHILDREN'S SER
CASP3283OtherSTATE LICENSE