Provider Demographics
NPI:1093066128
Name:OPEIL-KERNOSCHAK, JEANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:OPEIL-KERNOSCHAK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1659
Mailing Address - Country:US
Mailing Address - Phone:856-875-0646
Mailing Address - Fax:
Practice Address - Street 1:17 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1659
Practice Address - Country:US
Practice Address - Phone:856-875-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00480800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist