Provider Demographics
NPI:1861015604
Name:SPINA, JESSICA ANN (MS CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:SPINA
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:SPINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP, TSSLD
Mailing Address - Street 1:1668 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5007
Mailing Address - Country:US
Mailing Address - Phone:516-787-1172
Mailing Address - Fax:
Practice Address - Street 1:10 LAKE DR
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1123
Practice Address - Country:US
Practice Address - Phone:516-627-6391
Practice Address - Fax:516-627-2057
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist