Provider Demographics
NPI:1043525793
Name:BARTH, JEANNIE MARIA (MA,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIA
Last Name:BARTH
Suffix:
Gender:F
Credentials:MA,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 W HAMILTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4015
Mailing Address - Country:US
Mailing Address - Phone:813-930-0197
Mailing Address - Fax:813-930-2426
Practice Address - Street 1:3709 W HAMILTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4015
Practice Address - Country:US
Practice Address - Phone:813-930-0197
Practice Address - Fax:813-930-2426
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880866000Medicaid