Provider Demographics
NPI:1538460076
Name:WILLIAMS, JENNIFER GEARHART
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GEARHART
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:NEVERSINK
Mailing Address - State:NY
Mailing Address - Zip Code:12765-5036
Mailing Address - Country:US
Mailing Address - Phone:845-985-7305
Mailing Address - Fax:
Practice Address - Street 1:34 MOORE HILL RD
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740-5605
Practice Address - Country:US
Practice Address - Phone:845-985-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005383-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist