Provider Demographics
NPI:1104172204
Name:WONG, JOSELINNE (MA)
Entity type:Individual
Prefix:MRS
First Name:JOSELINNE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 CURRY FORD RD
Mailing Address - Street 2:#145
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4252
Mailing Address - Country:US
Mailing Address - Phone:956-227-2970
Mailing Address - Fax:
Practice Address - Street 1:5955 CURRY FORD RD
Practice Address - Street 2:#145
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4252
Practice Address - Country:US
Practice Address - Phone:956-227-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid