1174851349 NPI number — MRS. JENNIFER LYNNE D'ADDIO M.S.CCC-SLP

Table of content: DR. CHERYL SOBIERAJ WADHWA DDS (NPI 1104958438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174851349 NPI number — MRS. JENNIFER LYNNE D'ADDIO M.S.CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'ADDIO
Provider First Name:
JENNIFER
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONDOR
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174851349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 HATHORN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-8841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-581-9555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 WERNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-664-5066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  015306 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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