Provider Demographics
NPI:1073828380
Name:KIM-REHR, JENNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:KIM-REHR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHAMBERS STREET
Mailing Address - Street 2:NYC DEPT OF EDUCATION-OFFICE OF RELATED SERVICES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:212-374-0800
Mailing Address - Fax:
Practice Address - Street 1:1180 REVEREND JAMES A. POLITE AVE., ROOM 314
Practice Address - Street 2:METROPOLITAN HIGH SCHOOL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-991-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019742-1235Z00000X
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03798203Medicaid