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General NPI Number Information
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NPI Number | 1730363474
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Entity Type | Individual
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Provider Name | MS. JENNIFER TOI DOMINICK
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Gender | Female
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 5608 EMACK AVE
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City | LANHAM
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State | MD
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Zip | 20706-4004
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Country | US
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Telephone | 301-577-6883
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Fax | 301-459-6933
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Provider Business Mailing Address
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Address Line | 5608 EMACK AVE
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City | LANHAM
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State | MD
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Zip | 20706-4004
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Country | US
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Telephone | 301-577-6883
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Fax | 301-459-6933
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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