Healthcare Provider Details

I. General information

NPI: 1891910477
Provider Name (Legal Business Name): JESSICA FICARO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 WADING RIVER RD
CENTER MORICHES NY
11934-1107
US

IV. Provider business mailing address

158 WADING RIVER RD
CENTER MORICHES NY
11934-1107
US

V. Phone/Fax

Practice location:
  • Phone: 516-426-8443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: