Individual
MS. JENNA MARIE TELLERICO NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
30 AVON MEADOW LN, AVON, CT 06001-3745
(860) 284-9779
(860) 409-2190
Mailing address
PO BOX 421, AVON, CT 06001-0421
(860) 284-9779
(860) 409-2190
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5633
CT
Other
Enumeration date
07/17/2018
Last updated
09/11/2018
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