Healthcare Provider Details

I. General information

NPI: 1013845213
Provider Name (Legal Business Name): JOLIE HETTENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 08/12/2026
Certification Date: 05/10/2026
Deactivation Date: 05/15/2026
Reactivation Date: 08/12/2026

III. Provider practice location address

2069 BRIGHTON WAY
MERRICK NY
11566-5019
US

IV. Provider business mailing address

2069 BRIGHTON WAY
MERRICK NY
11566-5019
US

V. Phone/Fax

Practice location:
  • Phone: 516-254-5664
  • Fax:
Mailing address:
  • Phone: 516-254-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: