Provider Demographics
NPI:1104250505
Name:GUBENKO, JESSICA (MA, CFY)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GUBENKO
Suffix:
Gender:F
Credentials:MA, CFY
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 SILVERBIRCH RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 SILVERBIRCH RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3235
Practice Address - Country:US
Practice Address - Phone:516-527-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist