Healthcare Provider Details

I. General information

NPI: 1326686692
Provider Name (Legal Business Name): JENNIFER LYNNE CASINELLI CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP, UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

3 JUNE CT
WHITE PLAINS NY
10605-4608
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5105
  • Fax:
Mailing address:
  • Phone: 914-393-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: