Provider Demographics
NPI:1053716662
Name:FLAHERTY-PETTY, JACQUELINE (MS SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FLAHERTY-PETTY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BRESCIA BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1501
Mailing Address - Country:US
Mailing Address - Phone:845-489-0535
Mailing Address - Fax:
Practice Address - Street 1:9 BRESCIA BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1501
Practice Address - Country:US
Practice Address - Phone:845-489-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist