Provider Demographics
NPI:1770717019
Name:MARTUCCI, JENNIFER L (CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MARTUCCI
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 WARBURTON AVE APT 5W
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1017
Mailing Address - Country:US
Mailing Address - Phone:914-523-9862
Mailing Address - Fax:
Practice Address - Street 1:1155 WARBURTON AVE APT 5W
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1017
Practice Address - Country:US
Practice Address - Phone:914-523-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist