Provider Demographics
NPI:1629465844
Name:SLOAN, JOHANNA
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:SLOAN
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 1:41 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4426
Mailing Address - Country:US
Mailing Address - Phone:845-642-0001
Mailing Address - Fax:
Practice Address - Street 1:41 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-4426
Practice Address - Country:US
Practice Address - Phone:845-642-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services