Provider Demographics
NPI:1689957714
Name:WALD, JANICE M
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:WALD
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 1:10 BALCOM DR
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1514
Mailing Address - Country:US
Mailing Address - Phone:716-655-0836
Mailing Address - Fax:
Practice Address - Street 1:30 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-0217
Practice Address - Country:US
Practice Address - Phone:716-492-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001553-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist