Healthcare Provider Details

I. General information

NPI: 1427022631
Provider Name (Legal Business Name): AIMEE JENNINGS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W CALL ST
STARKE FL
32091-3115
US

IV. Provider business mailing address

417 W CALL ST
STARKE FL
32091-3115
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-4464
  • Fax: 904-964-4279
Mailing address:
  • Phone: 904-964-4464
  • Fax: 904-964-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5788
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: