MEDICARE: JENNIFER K MUNN 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	235Z00000X	Speech-Language Pathologist	100579	MA
2	235Z00000X	Speech-Language Pathologist	016493	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLP100579	OTHER	MA	MASSACHUSSETTS LICENSING BOARD
2	016493	OTHER	NY	NEW YORK STATE SPEECH LANGUAGE PATHOLOGY LICENSE NUMBER

General Provider Information

NPI Number	:	1891950226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER K MUNN CCC-SLP

Provider Business Mailing Address
First Line	:	100 WEBSTER COON RD
Second Line	:
City	:	MILAN
State	:	NY
Zip	:	12571-4143
Country	:	US
Telephone Number	:	458-943-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WEBSTER COON RD
Second Line	:
City	:	MILAN
State	:	NY
Zip	:	12571-4143
Country	:	US
Telephone Number	:	845-943-1212
Fax Number	:

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/26/2024

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Directions to “ JENNIFER K MUNN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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