Provider Demographics
NPI:1578872719
Name:JOANIS, STEPHEN P (MS,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:JOANIS
Suffix:
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 1:5104 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-2008
Mailing Address - Country:US
Mailing Address - Phone:651-216-1049
Mailing Address - Fax:
Practice Address - Street 1:5104 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-2008
Practice Address - Country:US
Practice Address - Phone:651-216-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist