Provider Demographics
NPI:1255693032
Name:AYLING, JENNIFER L (MS, ED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:AYLING
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:SWENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BEECH ST S
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 BEECH ST S
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4413
Practice Address - Country:US
Practice Address - Phone:516-639-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16877257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist