Provider Demographics
NPI:1053815449
Name:LESE, JILL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LESE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:TEITELBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:330 WEST 56TH ST.
Mailing Address - Street 2:APT. 21E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:301-448-8190
Mailing Address - Fax:773-754-8730
Practice Address - Street 1:330 WEST 56TH ST.
Practice Address - Street 2:APT. 21E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:301-448-8190
Practice Address - Fax:773-348-2073
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146015063235Z00000X
NY029869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist