Healthcare Provider Details

I. General information

NPI: 1982959318
Provider Name (Legal Business Name): JUDY ANN JENNER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 GOODLETTE RD N SUITE 140
NAPLES FL
34102-5469
US

IV. Provider business mailing address

873 CARRICK BEND CIR APT 101
NAPLES FL
34110-4601
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-9512
  • Fax: 239-643-5908
Mailing address:
  • Phone: 661-599-6769
  • Fax: 239-643-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: