Provider Demographics
NPI:1891752820
Name:FICCA, JOANN GILL (MED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:GILL
Last Name:FICCA
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BENFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1330
Mailing Address - Country:US
Mailing Address - Phone:609-799-3059
Mailing Address - Fax:
Practice Address - Street 1:21 BENFORD DRIVE
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1330
Practice Address - Country:US
Practice Address - Phone:609-799-3059
Practice Address - Fax:609-799-7841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00016600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist