Provider Demographics
NPI:1417284969
Name:AVITTO, JEANNE KATHLEEN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:KATHLEEN
Last Name:AVITTO
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DECKER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2113
Mailing Address - Country:US
Mailing Address - Phone:718-556-0484
Mailing Address - Fax:
Practice Address - Street 1:82 DECKER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2113
Practice Address - Country:US
Practice Address - Phone:718-556-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00396200235Z00000X
NY58 013244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist