Provider Demographics
NPI:1962551325
Name:LEDBETTER, JENNIFER MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 MERRICK ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-409-4327
Mailing Address - Fax:516-409-4328
Practice Address - Street 1:2631 MERRICK ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-409-4327
Practice Address - Fax:516-409-4328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1564231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist