Healthcare Provider Details

I. General information

NPI: 1235064403
Provider Name (Legal Business Name): JENNIFER SCHWARTZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 IDAHO AVE S
ST LOUIS PARK MN
55426-2115
US

IV. Provider business mailing address

1830 IDAHO AVE S
ST LOUIS PARK MN
55426-2115
US

V. Phone/Fax

Practice location:
  • Phone: 480-236-0286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP7904
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: