Provider Demographics
NPI:1730536467
Name:JOBIN, JOANNA ELIZABETH (MS)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ELIZABETH
Last Name:JOBIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ELIZABETH
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4701 VONA LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7380
Mailing Address - Country:US
Mailing Address - Phone:585-301-1876
Mailing Address - Fax:
Practice Address - Street 1:200 E 16TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4400
Practice Address - Country:US
Practice Address - Phone:301-662-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist