Healthcare Provider Details

I. General information

NPI: 1588596837
Provider Name (Legal Business Name): JENNIFER ASHLEY VINCENT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 176TH ST E
SPANAWAY WA
98387-8335
US

IV. Provider business mailing address

690 GRIDER POND RD
BOWLING GREEN KY
42104-0805
US

V. Phone/Fax

Practice location:
  • Phone: 253-800-2000
  • Fax:
Mailing address:
  • Phone: 270-543-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.LL.70039288
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: