Provider Demographics
NPI:1669968038
Name:JENNINGS, NATALIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1134
Mailing Address - Country:US
Mailing Address - Phone:845-534-8009
Mailing Address - Fax:
Practice Address - Street 1:67 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1441
Practice Address - Country:US
Practice Address - Phone:845-534-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist