Provider Demographics
NPI:1629190780
Name:NICHOLAS-RAGNO, JESSICA ELLEN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ELLEN
Last Name:NICHOLAS-RAGNO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ELLEN
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:998 VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2120
Mailing Address - Country:US
Mailing Address - Phone:516-521-5808
Mailing Address - Fax:
Practice Address - Street 1:998 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2120
Practice Address - Country:US
Practice Address - Phone:516-521-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist