Provider Demographics
NPI:1013349679
Name:MEHLICH, JENNIFER RUTH (SPED, MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RUTH
Last Name:MEHLICH
Suffix:
Gender:F
Credentials:SPED, MS
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RUTH
Other - Last Name:DIGNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPED, MS
Mailing Address - Street 1:287 WITTENBERG RD
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-5632
Mailing Address - Country:US
Mailing Address - Phone:845-684-5628
Mailing Address - Fax:
Practice Address - Street 1:287 WITTENBERG RD
Practice Address - Street 2:
Practice Address - City:BEARSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12409-5632
Practice Address - Country:US
Practice Address - Phone:845-684-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1850257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist