Jenna Rose Gustafson
Speech-Language Pathologist, in Ronkonkoma, NY. Individual provider (NPI-1).
NPI number1164092037
StatusActive
Last updated in NPPESJul 1, 2021
Details
- NPI
- 1164092037
- Entity type
- Individual (NPI-1)
- Name
- Jenna Rose Gustafson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 1, 2021
- Certification date
- Jun 29, 2021
- Last updated
- Jul 1, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | – | NY | Yes |
Practice location
624 Hawkins AveRonkonkoma, NY 11779-2375
Phone 631-240-3579
Mailing address
99 Forest DrJericho, NY 11753-2313
Phone 516-587-4777
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All 109 Speech-Language Pathologist providers in Ronkonkoma · All 866 providers in Ronkonkoma
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