Provider Demographics
NPI:1841796554
Name:HOBAN, JOAN KATHLEEN (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:KATHLEEN
Last Name:HOBAN
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 MCMULLEN HWY SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5152
Mailing Address - Country:US
Mailing Address - Phone:301-729-1219
Mailing Address - Fax:
Practice Address - Street 1:POTOMAC BEHAVIORAL AND OCCUPATIONAL THERAPY
Practice Address - Street 2:240 HENDERSON AVE.
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:240-362-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist