Provider Demographics
NPI:1669874244
Name:OLENDER, JESSICA KAREN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAREN
Last Name:OLENDER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:68 OLMSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2333
Mailing Address - Country:US
Mailing Address - Phone:716-697-0788
Mailing Address - Fax:
Practice Address - Street 1:331 ALBERTA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1813
Practice Address - Country:US
Practice Address - Phone:716-204-5925
Practice Address - Fax:716-204-5926
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY024772-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04168681Medicaid
NY325OtherMEDICAID CLN SP CD: EARLY INTERVENTION