Provider Demographics
NPI:1356786677
Name:BRUNO, JENNIFER L (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ZAVRA ST
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1714
Mailing Address - Country:US
Mailing Address - Phone:516-356-4842
Mailing Address - Fax:
Practice Address - Street 1:28 ZAVRA ST
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1714
Practice Address - Country:US
Practice Address - Phone:516-356-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist