Healthcare Provider Details

I. General information

NPI: 1598696460
Provider Name (Legal Business Name): JENNA BARBARA FERNAMBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 OKEECHOBEE BLVD STE 205
WEST PALM BEACH FL
33417-4486
US

IV. Provider business mailing address

3400 PERIWINKLE CT APT 114
PALM BEACH GARDENS FL
33410-2700
US

V. Phone/Fax

Practice location:
  • Phone: 561-376-2573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: