Provider Demographics
NPI:1821367400
Name:AMLAW-TENEYCK, JENNIFER (MA, CCC, LSLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:AMLAW-TENEYCK
Suffix:
Gender:F
Credentials:MA, CCC, LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1128
Mailing Address - Country:US
Mailing Address - Phone:518-393-0084
Mailing Address - Fax:
Practice Address - Street 1:1626 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2304
Practice Address - Country:US
Practice Address - Phone:518-377-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 018207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY58 018207OtherNEW YORK STATE LICENSE