Provider Demographics
NPI:1447494513
Name:PRATTS, JEANETTE (BIL TSHH)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:PRATTS
Suffix:
Gender:F
Credentials:BIL TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5323
Mailing Address - Country:US
Mailing Address - Phone:845-625-3877
Mailing Address - Fax:
Practice Address - Street 1:124 RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582
Practice Address - Country:US
Practice Address - Phone:845-625-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657712061171R00000X
NY364058031235Z00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171R00000XOther Service ProvidersInterpreter
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist