Provider Demographics
NPI:1922260157
Name:WACKS, JOYCE GRUENEBERG (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:GRUENEBERG
Last Name:WACKS
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 1:92 CAMBRIA CT
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5139
Mailing Address - Country:US
Mailing Address - Phone:401-475-5011
Mailing Address - Fax:
Practice Address - Street 1:92 CAMBRIA CT
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5139
Practice Address - Country:US
Practice Address - Phone:401-475-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI055859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist