Provider Demographics
NPI:1164223996
Name:AVELLINO, JENNIFER (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AVELLINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 SW MONTOVA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-8708
Mailing Address - Country:US
Mailing Address - Phone:772-275-5549
Mailing Address - Fax:772-673-8444
Practice Address - Street 1:8881 SW MONTOVA WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-8708
Practice Address - Country:US
Practice Address - Phone:772-275-5549
Practice Address - Fax:772-673-8444
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist