Basic Information
| Provider Information | |||||||||
| NPI: | 1245844778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOPPER | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MS CF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 S ALLEN ST APT 302 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122082058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104173875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182716777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.