Provider Demographics
NPI:1033605399
Name:DGIEN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DGIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1551
Mailing Address - Country:US
Mailing Address - Phone:607-968-6221
Mailing Address - Fax:607-968-6036
Practice Address - Street 1:7 CLEVELAND DR.
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801
Practice Address - Country:US
Practice Address - Phone:607-359-2261
Practice Address - Fax:607-359-4480
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist