Provider Demographics
NPI:1346377132
Name:HACKERT, JOANNE W (PHD,CCC)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:W
Last Name:HACKERT
Suffix:
Gender:F
Credentials:PHD,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6347
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-0096
Mailing Address - Country:US
Mailing Address - Phone:516-659-1906
Mailing Address - Fax:
Practice Address - Street 1:124 ERLANGER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1121
Practice Address - Country:US
Practice Address - Phone:516-659-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004030-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist