Provider Demographics
NPI:1275719841
Name:MALPEZZI, JENNIFER D (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:MALPEZZI
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 1:326 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1209
Mailing Address - Country:US
Mailing Address - Phone:315-977-4080
Mailing Address - Fax:315-733-0791
Practice Address - Street 1:326 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1209
Practice Address - Country:US
Practice Address - Phone:315-797-4080
Practice Address - Fax:315-738-7777
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01039156Medicaid
NY00474180Medicaid