| Doctor Name: | JAYNE MARIE HETTENBAUGH |
| NPI Number: | 1912152463 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. CCC-SLP |
| License Number: | 007795-1 |
| Business Practice Address: | 126 Larkin Street Ext Randolph, NY - 147729651 |
| Business Phone Number: | 7163589236 |
| Business Fax Number: | |
| Mailing Address: | P.o.box 53, 126 Larkin Street RANDOLPH |
| State: | NY |
| Postal Code: | 147720053 |
| Phone Number: | 7163589236 |
| Fax Number: | |
| NPI Enumeration Date: | 11/25/2008 |
| NPI Last Update Date: | 11/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 007795-1 |
| 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 |