Provider Demographics
NPI:1407000367
Name:BARTOLOTTA, JESSICA CATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:CATHERINE
Last Name:BARTOLOTTA
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:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:GLASCO
Mailing Address - State:NY
Mailing Address - Zip Code:12432-0737
Mailing Address - Country:US
Mailing Address - Phone:845-594-1374
Mailing Address - Fax:
Practice Address - Street 1:212 UNION ST
Practice Address - Street 2:
Practice Address - City:GLASCO
Practice Address - State:NY
Practice Address - Zip Code:12432
Practice Address - Country:US
Practice Address - Phone:845-594-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017529-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist