Provider Demographics
NPI:1578844288
Name:JONIENTZ, MICHELE M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:JONIENTZ
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 1:4217 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9770
Mailing Address - Country:US
Mailing Address - Phone:315-560-5089
Mailing Address - Fax:
Practice Address - Street 1:171 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3218
Practice Address - Country:US
Practice Address - Phone:315-435-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008094-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist