Provider Demographics
NPI:1588947907
Name:VIANT, JENNIFER (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VIANT
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 1:234 CARNATION AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3135
Mailing Address - Country:US
Mailing Address - Phone:917-748-1359
Mailing Address - Fax:
Practice Address - Street 1:6325 DRY HARBOR RD
Practice Address - Street 2:FOREST HILLS WEST SCHOOL
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1964
Practice Address - Country:US
Practice Address - Phone:718-639-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011905-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist