Provider Demographics
NPI:1942544309
Name:KABANIUK, JOANNE LYNN
Entity Type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:LYNN
Last Name:KABANIUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 BELLA PARK TRL
Mailing Address - Street 2:APT 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7096
Mailing Address - Country:US
Mailing Address - Phone:413-244-7534
Mailing Address - Fax:
Practice Address - Street 1:6610 CRESCENT MOON CT
Practice Address - Street 2:APT 301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3172
Practice Address - Country:US
Practice Address - Phone:413-244-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist