Provider Demographics
NPI:1780951723
Name:HENNESSY, MARIE WARD (MS)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:WARD
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6235
Mailing Address - Country:US
Mailing Address - Phone:716-649-7572
Mailing Address - Fax:
Practice Address - Street 1:150 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4828
Practice Address - Country:US
Practice Address - Phone:716-646-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist