Provider Demographics
NPI:1316190499
Name:MOULTON, JANET ELIZABETH (MA,CCC)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ELIZABETH
Last Name:MOULTON
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GREAT OAK LANE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2010
Mailing Address - Country:US
Mailing Address - Phone:914-769-1102
Mailing Address - Fax:
Practice Address - Street 1:75 GREAT OAK LANE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2010
Practice Address - Country:US
Practice Address - Phone:914-769-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003862-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist