Provider Demographics
NPI:1366695330
Name:WENTWORTH, JOEL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:WENTWORTH
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1716
Mailing Address - Country:US
Mailing Address - Phone:845-216-4381
Mailing Address - Fax:845-610-3247
Practice Address - Street 1:6 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1716
Practice Address - Country:US
Practice Address - Phone:845-216-4381
Practice Address - Fax:845-610-3247
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009918-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist