MEDICARE: A. JOURNEZ SPEECH AND LANGUAGE PATHOLOGY THERAPY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	012645	NY

General Provider Information

NPI Number	:	1083983910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. JOURNEZ SPEECH AND LANGUAGE PATHOLOGY THERAPY, P.C.

Provider Business Mailing Address
First Line	:	1542 MAIN ST
Second Line	:	SUITE 1
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1366
Country	:	US
Telephone Number	:	914-299-4052
Fax Number	:	914-526-8075

Provider Business Practice Location Address
First Line	:	1542 MAIN ST
Second Line	:	SUITE 1
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1366
Country	:	US
Telephone Number	:	914-299-4052
Fax Number	:	914-526-8075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ALEIA JOURNEZ CODNER
Credential	:	MSCCC-SLP
Telephone Number	:	914-299-4052

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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