Provider Demographics
NPI:1528663978
Name:RADONCIC, JESSICA (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RADONCIC
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 51ST ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6535
Mailing Address - Country:US
Mailing Address - Phone:917-302-3994
Mailing Address - Fax:
Practice Address - Street 1:351 W 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4402
Practice Address - Country:US
Practice Address - Phone:212-488-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist