Basic Information
| Provider Information | |||||||||
| NPI: | 1003957366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRIZNER | ||||||||
| FirstName: | JEANNETTE | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | MS,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 154014847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248806765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1160 VAN VOORHIS RD | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265053437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045981100 | ||||||||
| FaxNumber: | 3042851066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP-0814 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7402276000 | 05 | WV | MEDICAID |