Provider Demographics
NPI:1083588875
Name:KOTRY, JENELLE AMBERLY DOROTTA
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:AMBERLY DOROTTA
Last Name:KOTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:
Other - Last Name:DOROTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3155 STATE ROUTE 10 STE 8
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3492
Mailing Address - Country:US
Mailing Address - Phone:856-519-5780
Mailing Address - Fax:
Practice Address - Street 1:3155 STATE ROUTE 10 STE 8
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3492
Practice Address - Country:US
Practice Address - Phone:856-519-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist