Provider Demographics
NPI:1942472014
Name:GILLANDERS, JENNIFER (SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GILLANDERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1907
Mailing Address - Country:US
Mailing Address - Phone:631-868-0736
Mailing Address - Fax:
Practice Address - Street 1:481 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1907
Practice Address - Country:US
Practice Address - Phone:631-868-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist