Provider Demographics
NPI:1053564112
Name:BACA, GIOVANNA (SLP)
Entity type:Individual
Prefix:MS
First Name:GIOVANNA
Middle Name:
Last Name:BACA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5003
Mailing Address - Country:US
Mailing Address - Phone:845-724-4743
Mailing Address - Fax:
Practice Address - Street 1:44 CEDAR LN
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5003
Practice Address - Country:US
Practice Address - Phone:845-724-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016708-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist