MEDICARE: CHENNEY DEJESUS M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	235Z00000X	Speech-Language Pathologist	029729	NY

General Provider Information

NPI Number	:	1588155618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHENNEY DEJESUS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	19 GRANT AVE
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-3413
Country	:	US
Telephone Number	:	518-817-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BRICE ST
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-5101
Country	:	US
Telephone Number	:	518-843-2871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	05/27/2026

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