Provider Demographics
NPI:1114200516
Name:MATUSZAK, JENNIFER CHRISTINE (MS, CCC/L-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:MATUSZAK
Suffix:
Gender:F
Credentials:MS, CCC/L-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BEAVER MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:JAVA CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14082-9622
Mailing Address - Country:US
Mailing Address - Phone:716-492-9300
Mailing Address - Fax:
Practice Address - Street 1:12125 COUNTYLINE RD
Practice Address - Street 2:
Practice Address - City:YORKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:14173
Practice Address - Country:US
Practice Address - Phone:716-492-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist