MEDICARE: JAMIE YVONNE KITANOF 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	14509527	NY

General Provider Information

NPI Number	:	1376400010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE YVONNE KITANOF CCC-SLP

Provider Business Mailing Address
First Line	:	24 BOULEVARD DR
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-4838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	564 JACKSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3104
Country	:	US
Telephone Number	:	718-292-2683
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ JAMIE YVONNE KITANOF CCC-SLP” Practice Location

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