Provider Demographics
NPI:1386897015
Name:MCAULEY, JESSICA A (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:MCAULEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:SUGRUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, TSSLD
Mailing Address - Street 1:27 HERITAGE HLS UNIT D
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1235
Mailing Address - Country:US
Mailing Address - Phone:914-617-2160
Mailing Address - Fax:
Practice Address - Street 1:27 HERITAGE HLS UNIT D
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-1235
Practice Address - Country:US
Practice Address - Phone:914-617-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017522-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist