Healthcare Provider Details

I. General information

NPI: 1437327970
Provider Name (Legal Business Name): JENNIFER WALL ADAMS MED, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 ARBOR LN
HASLET TX
76052-3821
US

IV. Provider business mailing address

67 S HIGLEY RD STE 103-477
GILBERT AZ
85296-1166
US

V. Phone/Fax

Practice location:
  • Phone: 864-643-7732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number004335
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5085
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122796
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: