Provider Demographics
NPI:1013155985
Name:NG PACK, JEAN (MA, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:NG PACK
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16327 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1009
Mailing Address - Country:US
Mailing Address - Phone:917-952-3134
Mailing Address - Fax:
Practice Address - Street 1:16327 26TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1009
Practice Address - Country:US
Practice Address - Phone:917-952-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014038-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist