Provider Demographics
NPI:1528547148
Name:KING, JORI (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORI
Middle Name:
Last Name:KING
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 1:10858 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13485-3201
Mailing Address - Country:US
Mailing Address - Phone:219-309-7803
Mailing Address - Fax:
Practice Address - Street 1:4238 NEW YORK 8
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-1341
Practice Address - Country:US
Practice Address - Phone:607-847-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist