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General NPI Number Information
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NPI Number | 1457576365
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Entity Type | Individual
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Provider Name | JENNIFER L FREEMAN M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5517 N UNION VALLEY RD
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9570
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Country | US
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Telephone | 812-325-6142
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Fax | 812-876-4466
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Provider Business Mailing Address
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Address Line | 5517 N UNION VALLEY RD
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9570
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Country | US
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Telephone | 812-325-6142
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Fax | 812-876-4466
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22003846A
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License Number State | IN
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