Provider Demographics
NPI:1780880724
Name:SELISKAR, JEANNE R (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:R
Last Name:SELISKAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 DUNABBEY LOOP
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3437
Mailing Address - Country:US
Mailing Address - Phone:614-889-9089
Mailing Address - Fax:
Practice Address - Street 1:218 ELM ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-2130
Practice Address - Country:US
Practice Address - Phone:740-852-3100
Practice Address - Fax:740-852-7266
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist