Provider Demographics
NPI:1740437276
Name:SMITH, JENNIFER AUSTIN (MSCCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1007
Mailing Address - Country:US
Mailing Address - Phone:607-587-9377
Mailing Address - Fax:
Practice Address - Street 1:3135 ELM STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NY
Practice Address - Zip Code:14806
Practice Address - Country:US
Practice Address - Phone:607-478-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist