Provider Demographics
NPI:1780222562
Name:WOGHIN, JAYME (CF SLP MA TSSLD)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:WOGHIN
Suffix:
Gender:F
Credentials:CF SLP MA TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5406
Mailing Address - Country:US
Mailing Address - Phone:516-492-0873
Mailing Address - Fax:
Practice Address - Street 1:400 W MONTAUK HWY STE 152
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:631-669-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist