Provider Demographics
NPI:1538564281
Name:FRIEDMAN, JENNIFER WEISS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WEISS
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 116TH ST
Mailing Address - Street 2:PHA1109
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2864
Mailing Address - Country:US
Mailing Address - Phone:646-494-1236
Mailing Address - Fax:
Practice Address - Street 1:40 W 116TH ST
Practice Address - Street 2:PHA1109
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2864
Practice Address - Country:US
Practice Address - Phone:646-494-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011675-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist