Provider Demographics
NPI:1265670517
Name:ANTONINO, NANCY JEAN (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JEAN
Last Name:ANTONINO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:PROF
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:ANTONINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1989 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1578
Mailing Address - Country:US
Mailing Address - Phone:724-981-6856
Mailing Address - Fax:724-981-5176
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1726
Practice Address - Country:US
Practice Address - Phone:724-588-3001
Practice Address - Fax:724-588-9620
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001083L235Z00000X
OH2245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist