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NPI Code Detail

MEDICARE: JENNIFER VIANT MA, CCC/SLP

MEDICARE: JENNIFER VIANT MA, 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
1235Z00000XSpeech-Language Pathologist011905-1NY

General Provider Information

NPI Number : 1588947907
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER VIANT MA, CCC/SLP
Provider Business Mailing Address
First Line : 234 CARNATION AVE
Second Line :
City : FLORAL PARK
State : NY
Zip : 11001-3135
Country : US
Telephone Number : 917-748-1359
Fax Number :
Provider Business Practice Location Address
First Line : 6325 DRY HARBOR RD
Second Line : FOREST HILLS WEST SCHOOL
City : MIDDLE VILLAGE
State : NY
Zip : 11379-1964
Country : US
Telephone Number : 718-639-9750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 08/27/2020

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