Healthcare Provider Details

I. General information

NPI: 1962331199
Provider Name (Legal Business Name): JENNA ROSE MIELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MORRIS AVE STE 212
SPRINGFIELD NJ
07081-1020
US

IV. Provider business mailing address

80 BRITTEN RD
GREEN VILLAGE NJ
07935-3000
US

V. Phone/Fax

Practice location:
  • Phone: 908-441-7488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-5028
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: