Provider Demographics
NPI:1538543806
Name:PERUCCA, JEANETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:PERUCCA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:BARNHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6131
Mailing Address - Country:US
Mailing Address - Phone:516-639-8481
Mailing Address - Fax:
Practice Address - Street 1:2667 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4324
Practice Address - Country:US
Practice Address - Phone:516-765-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist