Provider Demographics
NPI:1053799528
Name:VERNI, JESSICA ANN (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:VERNI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:57 SOUTHERN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1091
Mailing Address - Country:US
Mailing Address - Phone:631-238-5785
Mailing Address - Fax:631-238-5785
Practice Address - Street 1:57 SOUTHERN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1091
Practice Address - Country:US
Practice Address - Phone:631-238-5785
Practice Address - Fax:631-238-5786
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01353231HA2400X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1942325527Medicaid
MD418796ZA6BMedicare PIN