Provider Demographics
NPI:1639295850
Name:HERTZENDORF-VITALE, JANA SKYE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:SKYE
Last Name:HERTZENDORF-VITALE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 GILDERSLEEVE ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2504
Mailing Address - Country:US
Mailing Address - Phone:516-771-2807
Mailing Address - Fax:
Practice Address - Street 1:7 MILLFORD DR
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1224
Practice Address - Country:US
Practice Address - Phone:516-771-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011630-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist