Healthcare Provider Details

I. General information

NPI: 1003977471
Provider Name (Legal Business Name): JENNIFER HARMON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MILLTOWN RD
EAST BRUNSWICK NJ
08816-2356
US

IV. Provider business mailing address

17 WILLIS CT
EAST BRUNSWICK NJ
08816-2885
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-1664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberYS 00430100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: