Healthcare Provider Details

I. General information

NPI: 1811422496
Provider Name (Legal Business Name): JENNIFER PAIGE JOHNSON FARINELLA M.S., CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER PAIGE JOHNSON M.S, CFY-SLP

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 CROWN POINT CT
JACKSONVILLE FL
32257-5967
US

IV. Provider business mailing address

3663 CROWN POINT CT
JACKSONVILLE FL
32257-5967
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-8910
  • Fax: 904-288-8912
Mailing address:
  • Phone: 904-288-8910
  • Fax: 904-288-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: