Provider Demographics
NPI:1598025652
Name:WAHMANN, JENNIFER NOELLE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOELLE
Last Name:WAHMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:NOELLE
Other - Last Name:D'AMBROSIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:4030 JERUSALEM AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1602
Mailing Address - Country:US
Mailing Address - Phone:516-781-5025
Mailing Address - Fax:
Practice Address - Street 1:4030 JERUSALEM AVE
Practice Address - Street 2:APT 2B
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1602
Practice Address - Country:US
Practice Address - Phone:516-781-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist