Provider Demographics
NPI:1578973806
Name:DEMOISE, JACQUELINE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DEMOISE
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DEMOISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPEECH THERAPIST
Mailing Address - Street 1:3390 SAXONBURG BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-3160
Mailing Address - Country:US
Mailing Address - Phone:412-767-5967
Mailing Address - Fax:412-767-5960
Practice Address - Street 1:3390 SAXONBURG BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-3160
Practice Address - Country:US
Practice Address - Phone:412-767-5967
Practice Address - Fax:412-767-5960
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist