Provider Demographics
NPI:1043656283
Name:VAN WINKLE, JENNIFER L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1205
Mailing Address - Country:US
Mailing Address - Phone:413-584-7234
Mailing Address - Fax:413-584-1896
Practice Address - Street 1:16 WEST ST
Practice Address - Street 2:
Practice Address - City:WEST HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01088-9515
Practice Address - Country:US
Practice Address - Phone:413-247-6112
Practice Address - Fax:413-247-6196
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist