Provider Demographics
NPI:1871320366
Name:RIVERA, JESSICA LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3635
Mailing Address - Country:US
Mailing Address - Phone:631-943-0801
Mailing Address - Fax:
Practice Address - Street 1:580 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8307
Practice Address - Country:US
Practice Address - Phone:631-943-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist