Provider Demographics
NPI:1790081099
Name:JACKSON-IACOBELLIS, NOREEN (MS-CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:NOREEN
Middle Name:
Last Name:JACKSON-IACOBELLIS
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FONDA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2705
Mailing Address - Country:US
Mailing Address - Phone:516-764-5015
Mailing Address - Fax:
Practice Address - Street 1:21 FONDA RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2705
Practice Address - Country:US
Practice Address - Phone:516-764-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist