Provider Demographics
NPI:1851628010
Name:AL-HADDAD, JEANAN (SLP)
Entity Type:Individual
Prefix:
First Name:JEANAN
Middle Name:
Last Name:AL-HADDAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DUDLEY ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1828
Mailing Address - Country:US
Mailing Address - Phone:617-894-0547
Mailing Address - Fax:
Practice Address - Street 1:186 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1507
Practice Address - Country:US
Practice Address - Phone:617-776-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist