Provider Demographics
NPI:1639424708
Name:SHARP, JENNIFER J (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:SHARP
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 1:47 GRAY AVNUE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834
Mailing Address - Country:US
Mailing Address - Phone:518-692-2801
Mailing Address - Fax:
Practice Address - Street 1:47 GRAY AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-1120
Practice Address - Country:US
Practice Address - Phone:518-692-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007919-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist