Provider Demographics
NPI:1215180997
Name:GALLUP, JENNIFER L (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:GALLUP
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 1:7 FOX HOLW
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14475-9704
Mailing Address - Country:US
Mailing Address - Phone:585-624-4510
Mailing Address - Fax:
Practice Address - Street 1:7 FOX HOLW
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:NY
Practice Address - Zip Code:14475-9704
Practice Address - Country:US
Practice Address - Phone:585-624-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012144-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist