Provider Demographics
NPI:1013109107
Name:DEL DUCA, JENNIFER BLACK (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BLACK
Last Name:DEL DUCA
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 1:1114 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1334
Mailing Address - Country:US
Mailing Address - Phone:412-559-1392
Mailing Address - Fax:724-871-1388
Practice Address - Street 1:1525 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1339
Practice Address - Country:US
Practice Address - Phone:412-559-1392
Practice Address - Fax:724-871-1388
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10196928000001Medicaid