Provider Demographics
NPI:1043756455
Name:LOVEJOY, JENNIFER RAE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:LOVEJOY
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 1:3120 25TH ST S STE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6110
Mailing Address - Country:US
Mailing Address - Phone:701-205-4194
Mailing Address - Fax:701-540-9044
Practice Address - Street 1:3120 25TH ST S STE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6110
Practice Address - Country:US
Practice Address - Phone:701-205-4194
Practice Address - Fax:701-540-9044
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112114235Z00000X
ND2290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist