Provider Demographics
NPI:1871733105
Name:JEFFREYS, MAUREEN B (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:B
Last Name:JEFFREYS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KUKUK LANE
Mailing Address - Street 2:CHILDREN'S ANNEX
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-336-2616
Mailing Address - Fax:
Practice Address - Street 1:70 KUKUK LANE
Practice Address - Street 2:CHILDREN'S ANNEX
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-336-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005543-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist