Provider Demographics
NPI:1386940302
Name:NANUS, JILL SAMANTHA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SAMANTHA
Last Name:NANUS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6901
Mailing Address - Country:US
Mailing Address - Phone:845-504-5271
Mailing Address - Fax:
Practice Address - Street 1:11 2ND ST
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-1712
Practice Address - Country:US
Practice Address - Phone:845-753-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist