Healthcare Provider Details

I. General information

NPI: 1275073629
Provider Name (Legal Business Name): JENNIFER MIONE MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14439 GRAVETT RD
FLUSHING NY
11367-1304
US

IV. Provider business mailing address

87 HARDING AVE
LYNBROOK NY
11563-1435
US

V. Phone/Fax

Practice location:
  • Phone: 718-793-2130
  • Fax:
Mailing address:
  • Phone: 516-640-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026511
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: