Provider Demographics
NPI:1912480187
Name:CAHILL, JENNA (SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:CAHILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:TESORIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1 MARK PL
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2256
Mailing Address - Country:US
Mailing Address - Phone:732-679-4714
Mailing Address - Fax:
Practice Address - Street 1:400 BELCHASE DR STE 406
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9760
Practice Address - Country:US
Practice Address - Phone:732-851-6947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00545100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist