Provider Demographics
NPI:1538326103
Name:HEDIN, JOHANNA D
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:D
Last Name:HEDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PRICE AVE # WE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4236
Mailing Address - Country:US
Mailing Address - Phone:716-484-2717
Mailing Address - Fax:
Practice Address - Street 1:165 PRICE AVE # WE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4236
Practice Address - Country:US
Practice Address - Phone:716-484-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009159-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist