Provider Demographics
NPI:1154645729
Name:PICONE, JENNIFER A
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:PICONE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:25 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1901
Mailing Address - Country:US
Mailing Address - Phone:781-620-0424
Mailing Address - Fax:
Practice Address - Street 1:12 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WARD HILL
Practice Address - State:MA
Practice Address - Zip Code:01835-6947
Practice Address - Country:US
Practice Address - Phone:978-374-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4590235Z00000X
NH0822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist