Healthcare Provider Details

I. General information

NPI: 1962760496
Provider Name (Legal Business Name): JENNIFER CAREY MS, CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7664 GERMANY CANAL RD
FORT PIERCE FL
34987-3300
US

IV. Provider business mailing address

256 NE SOLIDA DR
PORT ST LUCIE FL
34983-8440
US

V. Phone/Fax

Practice location:
  • Phone: 772-216-4412
  • Fax: 772-461-9954
Mailing address:
  • Phone: 772-342-1238
  • Fax: 772-461-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: