Healthcare Provider Details

I. General information

NPI: 1811264849
Provider Name (Legal Business Name): JENNIFER ANN VENTRY TSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E SPRING ST
OLEAN NY
14760-2907
US

IV. Provider business mailing address

12606 GUERNSEY HOLLOW RD
FREWSBURG NY
14738-9610
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-8920
  • Fax:
Mailing address:
  • Phone: 716-984-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: