Basic Information
| Provider Information | |||||||||
| NPI: | 1114382470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 E. SUNSET ROAD | ||||||||
| Address2: | UNIT 96595 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891931246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027980113 | ||||||||
| FaxNumber: | 8662915242 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 HARTFORD TPKE | ||||||||
| Address2: | ROUTE 83 | ||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060665245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606467900 | ||||||||
| FaxNumber: | 8606467792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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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 | 237700000X | 446 | CT | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.