Provider Demographics
NPI:1457505307
Name:MCCUMISKEY, JENNIFER ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:MCCUMISKEY
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 1:483 SHEFF RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13843-2215
Mailing Address - Country:US
Mailing Address - Phone:607-334-4753
Mailing Address - Fax:
Practice Address - Street 1:483 SHEFF RD
Practice Address - Street 2:
Practice Address - City:SOUTH NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13843-2215
Practice Address - Country:US
Practice Address - Phone:607-334-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010696-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist