Provider Demographics
NPI:1952443731
Name:KANE, JEAN MARION (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARION
Last Name:KANE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1876
Mailing Address - Country:US
Mailing Address - Phone:631-467-6469
Mailing Address - Fax:
Practice Address - Street 1:9 SMITHS LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3510
Practice Address - Country:US
Practice Address - Phone:631-543-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist