Provider Demographics
NPI:1578021184
Name:MOYNIHAN, JANELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAWRENCE HTS
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3079
Mailing Address - Country:US
Mailing Address - Phone:415-516-9653
Mailing Address - Fax:
Practice Address - Street 1:30 LAWRENCE HTS
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-3079
Practice Address - Country:US
Practice Address - Phone:415-516-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0130762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist