Provider Demographics
NPI:1215566039
Name:DILALLO, JENNIFER (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DILALLO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 JEWEL HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7255
Mailing Address - Country:US
Mailing Address - Phone:314-885-4812
Mailing Address - Fax:
Practice Address - Street 1:320 JEWEL HAVEN WAY
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7255
Practice Address - Country:US
Practice Address - Phone:314-885-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001312235Z00000X
TX120484235Z00000X
FLSA21655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist