Provider Demographics
NPI:1275833089
Name:SROUR, JENNIFER FRIEDA
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:FRIEDA
Last Name:SROUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 5TH AVENUE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2404
Mailing Address - Country:US
Mailing Address - Phone:718-833-5867
Mailing Address - Fax:
Practice Address - Street 1:9015 5TH AVENUE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2404
Practice Address - Country:US
Practice Address - Phone:718-833-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024431231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist