Provider Demographics
NPI:1891950226
Name:MUNN, JENNIFER K (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:MUNN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEBSTER COON RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:NY
Mailing Address - Zip Code:12571-4143
Mailing Address - Country:US
Mailing Address - Phone:458-943-1212
Mailing Address - Fax:
Practice Address - Street 1:100 WEBSTER COON RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:NY
Practice Address - Zip Code:12571-4143
Practice Address - Country:US
Practice Address - Phone:845-943-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100579235Z00000X
NY016493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASLP100579OtherMASSACHUSSETTS LICENSING BOARD
NY016493OtherNEW YORK STATE SPEECH LANGUAGE PATHOLOGY LICENSE NUMBER