Provider Demographics
NPI:1871840801
Name:BIENSTOCK, JESSICA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BIENSTOCK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 23RD ST
Mailing Address - Street 2:16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1132
Mailing Address - Country:US
Mailing Address - Phone:201-406-0894
Mailing Address - Fax:
Practice Address - Street 1:520 W 23RD ST
Practice Address - Street 2:16C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1132
Practice Address - Country:US
Practice Address - Phone:201-406-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 021985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist