Provider Demographics
NPI:1104112275
Name:CLEGHORNE, JO ANN (GUIDANCE COUNSELOR)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:CLEGHORNE
Suffix:
Gender:F
Credentials:GUIDANCE COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9424 239TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3823
Mailing Address - Country:US
Mailing Address - Phone:646-280-8418
Mailing Address - Fax:
Practice Address - Street 1:9424 239TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3823
Practice Address - Country:US
Practice Address - Phone:646-280-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1133855101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool