Provider Demographics
NPI:1457162901
Name:DHANESS, JOHN A JR (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:DHANESS
Suffix:JR
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12912 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1518
Mailing Address - Country:US
Mailing Address - Phone:347-337-2276
Mailing Address - Fax:
Practice Address - Street 1:408 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5173
Practice Address - Country:US
Practice Address - Phone:646-939-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist