Provider Demographics
NPI:1750629523
Name:QUINN-WHITE, JENNIFER M (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:QUINN-WHITE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26121 US ROUTE 11 STE 1
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3283
Mailing Address - Country:US
Mailing Address - Phone:315-221-5101
Mailing Address - Fax:315-681-4613
Practice Address - Street 1:26121 US ROUTE 11 STE 1
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3283
Practice Address - Country:US
Practice Address - Phone:315-221-5101
Practice Address - Fax:315-681-4613
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024060-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist