Provider Demographics
NPI:1477942753
Name:JAEGER, JEAN MARIE (NYS HAD)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:JAEGER
Suffix:
Gender:F
Credentials:NYS HAD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1216
Mailing Address - Country:US
Mailing Address - Phone:585-226-3040
Mailing Address - Fax:
Practice Address - Street 1:53 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1216
Practice Address - Country:US
Practice Address - Phone:585-226-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000028252237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist