Provider Demographics
NPI:1891025623
Name:BRADY, JENNIFER MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:5 SPLIT TREE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7833
Mailing Address - Country:US
Mailing Address - Phone:845-569-3011
Mailing Address - Fax:845-569-3011
Practice Address - Street 1:555 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7843
Practice Address - Country:US
Practice Address - Phone:845-527-2089
Practice Address - Fax:845-569-3011
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0189121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010958021Medicaid