Provider Demographics
NPI:1760646830
Name:MEZHIR, JENNIFER M (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MEZHIR
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PARK PL
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3521
Mailing Address - Country:US
Mailing Address - Phone:716-774-1344
Mailing Address - Fax:
Practice Address - Street 1:344 PARK PL
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-3521
Practice Address - Country:US
Practice Address - Phone:716-774-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011717-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist