Provider Demographics
NPI:1578960852
Name:PERRIN, JESSICA JAYNE (MS, CCC-SLP/NYSL)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JAYNE
Last Name:PERRIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP/NYSL
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:JAYNE
Other - Last Name:RAES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, TSSLD
Mailing Address - Street 1:131 DRUMLIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 STATE ROUTE 488
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9308
Practice Address - Country:US
Practice Address - Phone:315-548-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist