Healthcare Provider Details

I. General information

NPI: 1487831715
Provider Name (Legal Business Name): JENNIFER ELAINE WESTON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 WILD TAMARIND BLVD
ORLANDO FL
32828-9367
US

IV. Provider business mailing address

3014 WILD TAMARIND BLVD
ORLANDO FL
32828-9367
US

V. Phone/Fax

Practice location:
  • Phone: 727-743-3022
  • Fax: 321-281-4942
Mailing address:
  • Phone: 727-743-3022
  • Fax: 321-281-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 10001
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA 10001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: