Provider Demographics
NPI:1356187504
Name:VIGNANELLO, JACQUELINE YVONNE (MA, CCC-SLP, NYS-L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YVONNE
Last Name:VIGNANELLO
Suffix:
Gender:F
Credentials:MA, CCC-SLP, NYS-L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:Y
Other - Last Name:VIGNANELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:700 BROMLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9714
Mailing Address - Country:US
Mailing Address - Phone:905-746-5091
Mailing Address - Fax:
Practice Address - Street 1:160 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6215
Practice Address - Country:US
Practice Address - Phone:585-352-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist