Provider Demographics
NPI:1801195979
Name:MIRABELLA, JOANN (MA CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:MIRABELLA
Suffix:
Gender:F
Credentials:MA CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WREXHAM CT N
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8811
Mailing Address - Country:US
Mailing Address - Phone:716-834-2712
Mailing Address - Fax:
Practice Address - Street 1:313 WREXHAM CT. NORTH
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-834-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04554-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist