Provider Demographics
NPI:1497984934
Name:PASTORE, JENNIFER VERONICA (MS, CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VERONICA
Last Name:PASTORE
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 1:5604 NORMANDY AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2324
Mailing Address - Country:US
Mailing Address - Phone:757-498-0935
Mailing Address - Fax:
Practice Address - Street 1:5604 NORMANDY AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2324
Practice Address - Country:US
Practice Address - Phone:757-498-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist