Provider Demographics
NPI:1841573219
Name:REDANZ, JENNIFER ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:REDANZ
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 1:244 GRIMSBY RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1921
Mailing Address - Country:US
Mailing Address - Phone:716-875-6922
Mailing Address - Fax:
Practice Address - Street 1:600 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-3616
Practice Address - Country:US
Practice Address - Phone:716-694-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist