Provider Demographics
NPI:1366775306
Name:JANE HADDAD
Entity type:Organization
Organization Name:JANE HADDAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:HADDAD
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:562-439-6244
Mailing Address - Street 1:217 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:KINTNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18930-9764
Mailing Address - Country:US
Mailing Address - Phone:562-208-5048
Mailing Address - Fax:610-847-2989
Practice Address - Street 1:190 PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3153
Practice Address - Country:US
Practice Address - Phone:562-439-6244
Practice Address - Fax:562-438-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty