Provider Demographics
NPI:1306936703
Name:GIORDANELLI, JANIS (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:GIORDANELLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:
Other - Last Name:KUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:6 BRISTLECONE CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7324
Mailing Address - Country:US
Mailing Address - Phone:864-238-6243
Mailing Address - Fax:
Practice Address - Street 1:817 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4412
Practice Address - Country:US
Practice Address - Phone:864-232-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42677700Medicaid
SCSA0241Medicaid