Provider Demographics
NPI:1255633889
Name:DEPASQUALE, JENNIFER CATHERINE (MS-SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:DEPASQUALE
Suffix:
Gender:F
Credentials:MS-SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1037
Mailing Address - Country:US
Mailing Address - Phone:716-651-2004
Mailing Address - Fax:
Practice Address - Street 1:340 FOUGERON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1505
Practice Address - Country:US
Practice Address - Phone:716-816-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010424-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist