MEDICARE: VANESSA FACENDOLA M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00757800	NJ

General Provider Information

NPI Number	:	1295299691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA FACENDOLA M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	42 E REID PL
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1926
Country	:	US
Telephone Number	:	201-889-1519
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 BLOOMFIELD AVE STE 3
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3416
Country	:	US
Telephone Number	:	201-889-1519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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Directions to “ VANESSA FACENDOLA M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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