Provider Demographics
NPI:1043596554
Name:WALK, JENNIFER CARLISLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CARLISLE
Last Name:WALK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10 TEABURY LN
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1250
Mailing Address - Country:US
Mailing Address - Phone:732-222-5797
Mailing Address - Fax:
Practice Address - Street 1:14 BRIDGEWATERS DR
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1162
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:732-542-6606
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00290000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist