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General NPI Number Information
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NPI Number | 1285217885
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE BLECKINER CCC/SLP-L
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 129 W BARAGA AVE STE B
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City | MARQUETTE
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State | MI
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Zip | 49855-4759
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Country | US
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Telephone | 920-374-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 545 FISHER ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4523
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Country | US
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Telephone | 920-374-3062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101003668
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License Number State | MI
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