Provider Demographics
NPI:1164728796
Name:BLANE, JENNIFER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BLANE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1969
Mailing Address - Country:US
Mailing Address - Phone:219-743-0256
Mailing Address - Fax:219-390-7549
Practice Address - Street 1:10915 W 133RD AVE
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-9706
Practice Address - Country:US
Practice Address - Phone:219-390-7498
Practice Address - Fax:219-390-7549
Is Sole Proprietor?:No
Enumeration Date:2011-01-29
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist