Healthcare Provider Details

I. General information

NPI: 1699339846
Provider Name (Legal Business Name): JENNIFER ANNE OOSTDYK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JENNIFER ANNE HYLKEMA

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST
BRIGHTON MA
02135-3602
US

IV. Provider business mailing address

25 CHARLTON ST APT 503
EVERETT MA
02149-2472
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: