Healthcare Provider Details

I. General information

NPI: 1205752722
Provider Name (Legal Business Name): JENNIFER ELAINE SERIO M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 W 5TH ST OFC 2876B
LOS ANGELES CA
90071-2005
US

IV. Provider business mailing address

N172W19490 HIGHLAND RD
JACKSON WI
53037-9223
US

V. Phone/Fax

Practice location:
  • Phone: 512-377-6318
  • Fax:
Mailing address:
  • Phone: 512-377-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7337154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: