Provider Demographics
NPI:1265559835
Name:FODERARO, DORA HANNAH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:HANNAH
Last Name:FODERARO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 SUGARLOAF HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-1503
Mailing Address - Country:US
Mailing Address - Phone:570-788-6636
Mailing Address - Fax:
Practice Address - Street 1:1000 STACIE DR
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5690
Practice Address - Country:US
Practice Address - Phone:570-453-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist