Provider Demographics
NPI:1740560531
Name:BARTLE, JENNIFER L (CCC, NYS LIC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:BARTLE
Suffix:
Gender:F
Credentials:CCC, NYS LIC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830
Mailing Address - Country:US
Mailing Address - Phone:607-316-3584
Mailing Address - Fax:
Practice Address - Street 1:4238 STATE HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-2614
Practice Address - Country:US
Practice Address - Phone:607-847-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist