Provider Demographics
NPI:1093017782
Name:BREEN, JENNIFER LABELLE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LABELLE
Last Name:BREEN
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 1:136 RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:786-879-1254
Mailing Address - Fax:
Practice Address - Street 1:136 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-4507
Practice Address - Country:US
Practice Address - Phone:786-879-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8045153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist