Provider Demographics
NPI:1649552084
Name:POLCHINSKI, JILLIAN ROSE (MS)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ROSE
Last Name:POLCHINSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:RAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2885 FORTESQUE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2642
Mailing Address - Country:US
Mailing Address - Phone:516-851-3773
Mailing Address - Fax:
Practice Address - Street 1:2885 FORTESQUE AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2642
Practice Address - Country:US
Practice Address - Phone:516-851-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist