Provider Demographics
NPI:1720843667
Name:DEFALCO, JENNA (MA SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:MA SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MOUNTAIN LAUREL CT E
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-3603
Mailing Address - Country:US
Mailing Address - Phone:845-820-3667
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTAIN LAUREL CT E
Practice Address - Street 2:
Practice Address - City:SHOHOLA
Practice Address - State:PA
Practice Address - Zip Code:18458-3603
Practice Address - Country:US
Practice Address - Phone:845-820-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency