Individual
JOANN JOHANNESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 SHERWOOD DR, SHOREHAM, NY 11786-2054
(631) 255-6312
Mailing address
22 SHERWOOD DR, SHOREHAM, NY 11786-2054
(631) 255-6312
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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