Provider Demographics
NPI:1043425929
Name:HAVRANEK, JACQUELINE DEANNE (MS, CCC, SLP ,TSHH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DEANNE
Last Name:HAVRANEK
Suffix:
Gender:F
Credentials:MS, CCC, SLP ,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PARSONS ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-3711
Mailing Address - Country:US
Mailing Address - Phone:845-304-5140
Mailing Address - Fax:
Practice Address - Street 1:2826 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4514
Practice Address - Country:US
Practice Address - Phone:718-554-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist