Provider Demographics
NPI:1689717589
Name:WINTER-FAWCETT, JANET L (MS)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:WINTER-FAWCETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1114
Mailing Address - Country:US
Mailing Address - Phone:631-724-7529
Mailing Address - Fax:
Practice Address - Street 1:3 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1114
Practice Address - Country:US
Practice Address - Phone:631-724-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0083741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist