Provider Demographics
NPI:1417274341
Name:FALLERONI, JEFFREY (SLP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:FALLERONI
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1609
Mailing Address - Country:US
Mailing Address - Phone:484-595-9300
Mailing Address - Fax:484-595-0365
Practice Address - Street 1:5830 ELLSWORTH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1778
Practice Address - Country:US
Practice Address - Phone:484-595-9300
Practice Address - Fax:484-595-0365
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004651L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist