Provider Demographics
NPI:1598029399
Name:KELLY, JENNIFER L (MS, SPED)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, SPED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:GERENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SPED
Mailing Address - Street 1:1200 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9101
Mailing Address - Country:US
Mailing Address - Phone:585-737-8876
Mailing Address - Fax:
Practice Address - Street 1:41 COLEBROOK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-2211
Practice Address - Country:US
Practice Address - Phone:585-467-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY832017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist