Provider Demographics
NPI:1417555285
Name:GIORDANO, JACQUELINE YALE (MS CCC-SLP (CT&NY))
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:YALE
Last Name:GIORDANO
Suffix:
Gender:F
Credentials:MS CCC-SLP (CT&NY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4790
Mailing Address - Country:US
Mailing Address - Phone:203-448-7768
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST STE 13
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2942
Practice Address - Country:US
Practice Address - Phone:203-481-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030240235Z00000X
CT18.005956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty