Provider Demographics
NPI:1316219330
Name:MORAN, JENNIFER SCHWERN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SCHWERN
Last Name:MORAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2530
Mailing Address - Country:US
Mailing Address - Phone:518-584-5058
Mailing Address - Fax:
Practice Address - Street 1:100 CLINTON RD
Practice Address - Street 2:BLUE CREEK ELEMENTARY SCHOOL
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4200
Practice Address - Country:US
Practice Address - Phone:518-785-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016369-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist