Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jenna Rose Gustafson

Individual provider Speech-Language Pathologist · NPI 1164092037

Jenna Rose Gustafson is a Speech-Language Pathologist in Ronkonkoma, New York. Licensed in New York. Registered with an NPI since 2021.

Licensed in
NY
In the registry since
2021

Practice location Address checks out

624 Hawkins Ave
Ronkonkoma, NY 11779-2375
Phone: (631) 240-3579
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X (NY)

Record details

NPI number1164092037
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 1, 2021
Last updated in NPPESJuly 1, 2021
Certification dateJune 29, 2021
Mailing address99 Forest Dr, Jericho, NY 11753-2313

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