Provider Demographics
NPI:1649415829
Name:DIBENEDETTO, JENNIFER LYNN (MS; SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:MS; SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21424 45TH RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3338
Mailing Address - Country:US
Mailing Address - Phone:718-352-7217
Mailing Address - Fax:718-352-7217
Practice Address - Street 1:21424 45TH RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3338
Practice Address - Country:US
Practice Address - Phone:718-352-7217
Practice Address - Fax:718-352-7217
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist