Provider Demographics
NPI:1760895718
Name:NEAL, JANIS WHITNEY-FREMONT (MA)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:WHITNEY-FREMONT
Last Name:NEAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16880 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3336
Mailing Address - Country:US
Mailing Address - Phone:734-513-5766
Mailing Address - Fax:
Practice Address - Street 1:3636 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-2032
Practice Address - Country:US
Practice Address - Phone:864-884-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist