Provider Demographics
NPI:1487039483
Name:PELLICORI, JENNA MARIE (AUD)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MARIE
Last Name:PELLICORI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WHITE HORSE RD
Mailing Address - Street 2:SUITE #510
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4406
Mailing Address - Country:US
Mailing Address - Phone:856-627-4400
Mailing Address - Fax:856-627-4401
Practice Address - Street 1:1000 WHITE HORSE RD
Practice Address - Street 2:SUITE #510
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:856-627-4400
Practice Address - Fax:856-627-4401
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00091300231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist