Provider Demographics
NPI:1265687354
Name:ROULET, JEANNE M (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:ROULET
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 1:43 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3016
Mailing Address - Country:US
Mailing Address - Phone:516-755-0890
Mailing Address - Fax:516-249-5437
Practice Address - Street 1:43 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3016
Practice Address - Country:US
Practice Address - Phone:516-755-0890
Practice Address - Fax:516-249-5437
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007786-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist