Provider Demographics
NPI:1952076093
Name:SPELLMAN, JESSICA H (CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials: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 1:18 CRESKILL PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2451
Mailing Address - Country:US
Mailing Address - Phone:631-805-4666
Mailing Address - Fax:
Practice Address - Street 1:18 CRESKILL PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2451
Practice Address - Country:US
Practice Address - Phone:631-805-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030596-01246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology