Healthcare Provider Details

I. General information

NPI: 1811211402
Provider Name (Legal Business Name): JENNIFER R CALLAHAN MA CCC-LSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 LYNDON RD
FRANKLINVILLE NY
14737-9786
US

IV. Provider business mailing address

2369 LYNDON RD
FRANKLINVILLE NY
14737-9786
US

V. Phone/Fax

Practice location:
  • Phone: 716-604-6754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016276-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: