Doctor Name: | MS. JEN DENISE PRUE |
NPI Number: | 1649400367 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 58018652 |
Business Practice Address: | 70 Kukuk Ln Kingston, NY - 124016943 |
Business Phone Number: | 8453362616 |
Business Fax Number: | |
Mailing Address: | 365 Sahler Mill Rd, OLIVEBRIDGE |
State: | NY |
Postal Code: | 124615214 |
Phone Number: | 9144566141 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2009 |
NPI Last Update Date: | 07/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 58018652 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |