Provider Demographics
NPI:1417147828
Name:HUPRICH, JOANN STASIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:STASIA
Last Name:HUPRICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:STASIA
Other - Last Name:SIBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 741644
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-1644
Mailing Address - Country:US
Mailing Address - Phone:561-252-5030
Mailing Address - Fax:
Practice Address - Street 1:5550 SPRING LAKE TER
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3350
Practice Address - Country:US
Practice Address - Phone:561-252-5030
Practice Address - Fax:561-732-3397
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist