Provider Demographics
NPI:1639491210
Name:HUDAK, JENNIFER E (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:HUDAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2559
Mailing Address - Country:US
Mailing Address - Phone:330-225-4182
Mailing Address - Fax:330-225-4879
Practice Address - Street 1:63 GRAHAM RD STE 2
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1204
Practice Address - Country:US
Practice Address - Phone:330-752-4370
Practice Address - Fax:866-851-8273
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist