Provider Demographics
NPI:1457620411
Name:FREY, JENNIFER L (MS, CCC/LSLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FREY
Suffix:
Gender:F
Credentials:MS, CCC/LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-9798
Mailing Address - Country:US
Mailing Address - Phone:716-751-9341
Mailing Address - Fax:
Practice Address - Street 1:430 YOUNG ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9745
Practice Address - Country:US
Practice Address - Phone:716-751-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009797-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist