Provider Demographics
NPI:1194095299
Name:VON BISCHOFFSHAUSEN, JOELLE MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:MARIE
Last Name:VON BISCHOFFSHAUSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 S MANHEIM BLVD
Mailing Address - Street 2:APT. 1
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2462
Mailing Address - Country:US
Mailing Address - Phone:732-407-3419
Mailing Address - Fax:
Practice Address - Street 1:101 MANSION ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2412
Practice Address - Country:US
Practice Address - Phone:845-451-4690
Practice Address - Fax:845-451-4701
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021603-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist