| Doctor Name: | MRS. JESSICA ANN CIRILLO WENCK |
| NPI Number: | 1093094765 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A.-CCC- SLP |
| License Number: | 58021265 |
| Business Practice Address: | 309 W Thurston St Elmira, NY - 149011124 |
| Business Phone Number: | 6077353000 |
| Business Fax Number: | |
| Mailing Address: | 222 Roosevelt Ave Apt 10, HORSEHEADS |
| State: | NY |
| Postal Code: | 148458233 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2011 |
| NPI Last Update Date: | 12/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 58021265 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |