Provider Demographics
NPI:1487934402
Name:GALVIN, JOHANNA PATRICIA (SLP/CCC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:PATRICIA
Last Name:GALVIN
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 RTE 79
Mailing Address - Street 2:WINDSOR
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-2719
Mailing Address - Country:US
Mailing Address - Phone:607-349-4333
Mailing Address - Fax:
Practice Address - Street 1:882 RTE 79
Practice Address - Street 2:WINDSOR
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-2719
Practice Address - Country:US
Practice Address - Phone:607-349-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist