Provider Demographics
NPI:1265742761
Name:JOAN, NEIL (MA, MS)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:JOAN
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10841 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1366
Mailing Address - Country:US
Mailing Address - Phone:786-281-0755
Mailing Address - Fax:
Practice Address - Street 1:10841 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1366
Practice Address - Country:US
Practice Address - Phone:786-281-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist