Provider Demographics
NPI:1558795195
Name:JABLIN, MELISSA ERIN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:JABLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 JOLINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-2080
Mailing Address - Country:US
Mailing Address - Phone:718-637-4863
Mailing Address - Fax:718-439-6415
Practice Address - Street 1:223 JOLINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-2080
Practice Address - Country:US
Practice Address - Phone:718-637-4863
Practice Address - Fax:718-439-6415
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist