1891950226 NPI number — JENNIFER K MUNN CCC-SLP

Table of content: JENNIFER K MUNN CCC-SLP (NPI 1891950226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891950226 NPI number — JENNIFER K MUNN CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNN
Provider First Name:
JENNIFER
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891950226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WEBSTER COON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12571-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
458-943-1212
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WEBSTER COON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12571-4143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-943-1212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2008

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:  100579 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 016493 , 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)

  • Identifier: SLP100579 . This is a "MASSACHUSSETTS LICENSING BOARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 016493 . This is a "NEW YORK STATE SPEECH LANGUAGE PATHOLOGY LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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