Provider Demographics
NPI:1003030446
Name:KERTZNER, JODIE LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:LYNN
Last Name:KERTZNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 KAYRON LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2116
Mailing Address - Country:US
Mailing Address - Phone:917-292-8228
Mailing Address - Fax:
Practice Address - Street 1:2442 KAYRON LN
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2116
Practice Address - Country:US
Practice Address - Phone:917-292-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0097551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist