Provider Demographics
NPI:1700363769
Name:MANSUR, JESSICA LYNN (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MANSUR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:STRZEPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:114 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2329
Mailing Address - Country:US
Mailing Address - Phone:315-735-3536
Mailing Address - Fax:315-624-9414
Practice Address - Street 1:114 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2329
Practice Address - Country:US
Practice Address - Phone:315-735-3536
Practice Address - Fax:156-249-4143
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4102231H00000X
NY003165231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist