Provider Demographics
NPI:1083186878
Name:JENIFER, CATHERINE M (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:M
Last Name:JENIFER
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 1:2521 WOODLAND TER
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4608
Mailing Address - Country:US
Mailing Address - Phone:410-474-0780
Mailing Address - Fax:
Practice Address - Street 1:1450 DARES BEACH RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4206
Practice Address - Country:US
Practice Address - Phone:410-550-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist