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General NPI Number Information
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NPI Number | 1679865406
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Entity Type | Individual
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Provider Name | GENE WESLEY HOMER M.ED., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 15 PEARL ST E
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City | SIDNEY
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State | NY
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Zip | 13838-1597
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Country | US
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Telephone | 607-563-2135
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LA BARRE ST
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City | HANCOCK
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State | NY
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Zip | 13783-1217
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Country | US
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Telephone | 607-637-2796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 06103-1
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License Number State | NY
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