Provider Demographics
NPI:1053645390
Name:GIBBS, JENNIFER LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 N MILLER RD
Mailing Address - Street 2:BLDG. 150A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3770
Mailing Address - Country:US
Mailing Address - Phone:330-867-2240
Mailing Address - Fax:330-867-2245
Practice Address - Street 1:3637 MEDINA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9654
Practice Address - Country:US
Practice Address - Phone:330-952-0403
Practice Address - Fax:330-952-0826
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist