Provider Demographics
NPI:1629353545
Name:VAN HOESEN, LINDA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:VAN HOESEN
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 1:120 FLATS ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015
Mailing Address - Country:US
Mailing Address - Phone:518-945-3830
Mailing Address - Fax:
Practice Address - Street 1:120 FLATS ROAD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:NY
Practice Address - Zip Code:12015
Practice Address - Country:US
Practice Address - Phone:518-945-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012228-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist