Provider Demographics
NPI:1003509282
Name:IMBROGNO, JACQUELINE ANN (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:IMBROGNO
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:GRETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:2230 ROUTE 70 W STE 2
Mailing Address - Street 2:1141
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:610-804-8382
Mailing Address - Fax:
Practice Address - Street 1:57 E MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1059
Practice Address - Country:US
Practice Address - Phone:610-804-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009251235Z00000X
NJ41YS01119300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist