Provider Demographics
NPI:1316401789
Name:TAURISANI, JENNA (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:TAURISANI
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:OLDFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, TSSLD
Mailing Address - Street 1:269 TYRCONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3150
Mailing Address - Country:US
Mailing Address - Phone:845-807-1594
Mailing Address - Fax:
Practice Address - Street 1:269 TYRCONNELL AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3150
Practice Address - Country:US
Practice Address - Phone:845-807-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028222-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty