Provider Demographics
NPI:1508532854
Name:FONTANA, JESSICA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 GRAVES ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6937
Mailing Address - Country:US
Mailing Address - Phone:646-410-6224
Mailing Address - Fax:
Practice Address - Street 1:3767 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3827
Practice Address - Country:US
Practice Address - Phone:718-967-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist