MEDICARE: JANE HADDAD

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	SP9815	CA

General Provider Information

NPI Number	:	1366775306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE HADDAD

Provider Business Mailing Address
First Line	:	217 ISLAND RD
Second Line	:
City	:	KINTNERSVILLE
State	:	PA
Zip	:	18930-9764
Country	:	US
Telephone Number	:	562-208-5048
Fax Number	:	610-847-2989

Provider Business Practice Location Address
First Line	:	190 PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3153
Country	:	US
Telephone Number	:	562-439-6244
Fax Number	:	562-438-6244

Authorized Official
Title or Position	:	SPECH PATHOLOGIST
Name	:	MS. JANE HADDAD STUART
Credential	:	MA, CCC-SLP
Telephone Number	:	562-439-6244

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	03/06/2023

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