Provider Demographics
NPI:1922370220
Name:TONG, JENNIFER LINDA (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDA
Last Name:TONG
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JEROME ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5731
Mailing Address - Country:US
Mailing Address - Phone:631-804-3856
Mailing Address - Fax:
Practice Address - Street 1:180 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2830
Practice Address - Country:US
Practice Address - Phone:631-269-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018617-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist