Provider Demographics
NPI:1801048160
Name:RANDON, GEANNINE ANN
Entity type:Individual
Prefix:
First Name:GEANNINE
Middle Name:ANN
Last Name:RANDON
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 1:6738 HILLCROFT DR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025-9645
Mailing Address - Country:US
Mailing Address - Phone:716-941-6926
Mailing Address - Fax:
Practice Address - Street 1:6738 HILLCROFT DR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:NY
Practice Address - Zip Code:14025-9645
Practice Address - Country:US
Practice Address - Phone:716-941-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006539-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist