Basic Information
| Provider Information | |||||||||
| NPI: | 1275719841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALPEZZI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 CATHERINE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135011209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3159774080 | ||||||||
| FaxNumber: | 3157330791 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 CATHERINE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135011209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157974080 | ||||||||
| FaxNumber: | 3157387777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 03/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 008734 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 01039156 | 05 | NY | MEDICAID | 00474180 | 05 | NY | MEDICAID |