Provider Demographics
NPI:1073826640
Name:KAMINSKI, JEANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:127 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3115
Mailing Address - Country:US
Mailing Address - Phone:631-589-6693
Mailing Address - Fax:
Practice Address - Street 1:1227 MONTAUK HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1492
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:631-218-2650
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist