Provider Demographics
NPI:1295985562
Name:PERKINS, JEAN FETZNER (MS ED SLP CCC L)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:FETZNER
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MS ED SLP CCC L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 ROUTE 77
Mailing Address - Street 2:
Mailing Address - City:STRYKERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14145-9535
Mailing Address - Country:US
Mailing Address - Phone:585-591-1205
Mailing Address - Fax:
Practice Address - Street 1:1878 ROUTE 77
Practice Address - Street 2:
Practice Address - City:STRYKERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14145-9535
Practice Address - Country:US
Practice Address - Phone:585-591-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist