Provider Demographics
NPI:1114382470
Name:GANO, JENNIFER L (HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GANO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E. SUNSET ROAD
Mailing Address - Street 2:UNIT 96595
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-1246
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:27 HARTFORD TPKE
Practice Address - Street 2:ROUTE 83
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5245
Practice Address - Country:US
Practice Address - Phone:860-646-7900
Practice Address - Fax:860-646-7792
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT446237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist