Provider Demographics
NPI:1417266941
Name:ALLESSI, JILLIAN RAE (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:RAE
Last Name:ALLESSI
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 1:89 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2503
Mailing Address - Country:US
Mailing Address - Phone:716-822-1442
Mailing Address - Fax:
Practice Address - Street 1:4363 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9652
Practice Address - Country:US
Practice Address - Phone:716-625-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist