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NPI Code Detail

MEDICARE: JORDAN LYN JANUSZKA

MEDICARE: JORDAN LYN JANUSZKA
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1992479844
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LYN JANUSZKA
Provider Business Mailing Address
First Line : 8685 ERIE RD
Second Line :
City : ANGOLA
State : NY
Zip : 14006-9620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10469 BANTLE RD
Second Line :
City : NORTH COLLINS
State : NY
Zip : 14111-9781
Country : US
Telephone Number : 716-337-0166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2021
Last Update Date : 08/04/2021

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Directions to “ JORDAN LYN JANUSZKA ” Practice Location

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