Provider Demographics
NPI:1457582298
Name:VREENEGOOR, JENNIFER ANNE (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:VREENEGOOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:DI NUBILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:7115 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2105
Mailing Address - Country:US
Mailing Address - Phone:718-232-0685
Mailing Address - Fax:
Practice Address - Street 1:7115 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2105
Practice Address - Country:US
Practice Address - Phone:718-232-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017229-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist