Provider Demographics
NPI:1003387713
Name:HUNT, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22283 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9273
Mailing Address - Country:US
Mailing Address - Phone:734-512-8119
Mailing Address - Fax:
Practice Address - Street 1:25330 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2105
Practice Address - Country:US
Practice Address - Phone:313-531-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist