Provider Demographics
NPI:1063921658
Name:LYNCH, JESSIE F (MS)
Entity type:Individual
Prefix:MISS
First Name:JESSIE
Middle Name:F
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3626
Mailing Address - Country:US
Mailing Address - Phone:631-275-0178
Mailing Address - Fax:
Practice Address - Street 1:175 WOLF HILL RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1340
Practice Address - Country:US
Practice Address - Phone:631-423-7700
Practice Address - Fax:631-423-7706
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY975927235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist