Provider Demographics
NPI:1003166976
Name:MCNERNEY, JENNIFER LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8197 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5507
Mailing Address - Country:US
Mailing Address - Phone:310-529-6121
Mailing Address - Fax:
Practice Address - Street 1:8197 MILLER DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504
Practice Address - Country:US
Practice Address - Phone:310-529-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0002574OtherDEPARTMENT OF REGULATORY AGENCIES
12082195OtherAMERICAN SPEECH AND HEARING ASSOCIATION