Healthcare Provider Details

I. General information

NPI: 1013349679
Provider Name (Legal Business Name): JENNIFER RUTH MEHLICH SPED, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RUTH DIGNON SPED, M.S.

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 WITTENBERG RD
BEARSVILLE NY
12409-5632
US

IV. Provider business mailing address

287 WITTENBERG RD
BEARSVILLE NY
12409-5632
US

V. Phone/Fax

Practice location:
  • Phone: 845-684-5628
  • Fax:
Mailing address:
  • Phone: 845-684-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1850257
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: