Provider Demographics
NPI:1790803930
Name:WAXMAN, JEANNE HOM (MS, CCC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:HOM
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3138
Mailing Address - Country:US
Mailing Address - Phone:973-422-1283
Mailing Address - Fax:973-422-1283
Practice Address - Street 1:46 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3138
Practice Address - Country:US
Practice Address - Phone:973-422-1283
Practice Address - Fax:973-422-1283
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS0349500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist