Provider Demographics
NPI:1356741235
Name:SEGARRA, JUANITA
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:SEGARRA
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 1:219 WEST GROVE STREET, LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9348
Mailing Address - Country:US
Mailing Address - Phone:570-319-0244
Mailing Address - Fax:570-338-4480
Practice Address - Street 1:219 W GROVE ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2023
Practice Address - Country:US
Practice Address - Phone:570-319-0244
Practice Address - Fax:570-338-4480
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03317237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist