Provider Demographics
NPI:1467700377
Name:PORTNEY, JENNIE CLAIRE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:CLAIRE
Last Name:PORTNEY
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 1:1123 COUNTY ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-6029
Mailing Address - Country:US
Mailing Address - Phone:610-246-4651
Mailing Address - Fax:
Practice Address - Street 1:1123 COUNTY ROUTE 6
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-6029
Practice Address - Country:US
Practice Address - Phone:610-246-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist