Provider Demographics
NPI:1306081062
Name:WALDMAN, LOIS JEAN (MA)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:JEAN
Last Name:WALDMAN
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 1:363 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1512
Mailing Address - Country:US
Mailing Address - Phone:973-223-7761
Mailing Address - Fax:
Practice Address - Street 1:363 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1512
Practice Address - Country:US
Practice Address - Phone:973-223-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003818-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist