MEDICARE: JENNA ELLEN CASSIDY SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	029371	NY

General Provider Information

NPI Number	:	1841837739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ELLEN CASSIDY SLP

Provider Business Mailing Address
First Line	:	1340 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5315
Country	:	US
Telephone Number	:	718-758-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5315
Country	:	US
Telephone Number	:	718-758-8970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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Directions to “ JENNA ELLEN CASSIDY SLP” Practice Location

Language	Start Address	Practice Location

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