Healthcare Provider Details

I. General information

NPI: 1215815642
Provider Name (Legal Business Name): JENNIFER WURTH MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9919 TOWNE RD
CARMEL IN
46032-8260
US

IV. Provider business mailing address

9919 TOWNE RD
CARMEL IN
46032-8260
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-4166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22007906A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: