Provider Demographics
NPI:1114239381
Name:FRYE, JENNIFER NOEL (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOEL
Last Name:FRYE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELM ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2500
Mailing Address - Country:US
Mailing Address - Phone:207-356-8211
Mailing Address - Fax:
Practice Address - Street 1:1372 NEWBURY NECK RD
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3819
Practice Address - Country:US
Practice Address - Phone:207-356-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST1788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist