Provider Demographics
NPI:1669700613
Name:POOLE, JOANN NEU (MACCCSP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:NEU
Last Name:POOLE
Suffix:
Gender:F
Credentials:MACCCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W. SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5204
Mailing Address - Country:US
Mailing Address - Phone:909-621-2780
Mailing Address - Fax:909-621-2790
Practice Address - Street 1:309 E. ROWLAND ST.
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3152
Practice Address - Country:US
Practice Address - Phone:626-214-9311
Practice Address - Fax:626-214-9314
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist