Provider Demographics
NPI:1164710695
Name:BESELER, JEANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:BESELER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1603
Mailing Address - Country:US
Mailing Address - Phone:631-249-1156
Mailing Address - Fax:
Practice Address - Street 1:79 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1603
Practice Address - Country:US
Practice Address - Phone:631-249-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007891-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist