Provider Demographics
NPI:1083165534
Name:HARLOW, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HARLOW
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 1:17506 BRIGHT WHEAT DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4331
Mailing Address - Country:US
Mailing Address - Phone:217-836-6627
Mailing Address - Fax:
Practice Address - Street 1:17506 BRIGHT WHEAT DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4331
Practice Address - Country:US
Practice Address - Phone:217-836-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency