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NPI Code Detail

MEDICARE: JENNIFER CANTERBURY M.S. CCC-SLP

MEDICARE: JENNIFER CANTERBURY M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist106586TX

General Provider Information

NPI Number : 1871858969
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER CANTERBURY M.S. CCC-SLP
Provider Business Mailing Address
First Line : 197 THOMAS JOHNSON DR STE B
Second Line :
City : FREDERICK
State : MD
Zip : 21702-4314
Country : US
Telephone Number : 301-662-1997
Fax Number :
Provider Business Practice Location Address
First Line : 15911 NACOGDOCHES RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-1107
Country : US
Telephone Number : 210-599-7733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2012
Last Update Date : 12/06/2019

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