Provider Demographics
NPI:1083831481
Name:SHANK, JENNIFER L
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SHANK
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 1:19398 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:ARGOS
Mailing Address - State:IN
Mailing Address - Zip Code:46501-9765
Mailing Address - Country:US
Mailing Address - Phone:574-892-5920
Mailing Address - Fax:
Practice Address - Street 1:19398 LINDEN RD
Practice Address - Street 2:
Practice Address - City:ARGOS
Practice Address - State:IN
Practice Address - Zip Code:46501-9765
Practice Address - Country:US
Practice Address - Phone:574-892-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003547A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist