Provider Demographics
NPI:1043651227
Name:CONDREY, JOANNA S (MS,CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:S
Last Name:CONDREY
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 N SAINT MARIE RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-4412
Mailing Address - Country:US
Mailing Address - Phone:618-204-7622
Mailing Address - Fax:618-395-8410
Practice Address - Street 1:410 E MACK AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2319
Practice Address - Country:US
Practice Address - Phone:618-204-7622
Practice Address - Fax:618-395-8410
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist