Provider Demographics
NPI:1235772013
Name:FAULK, JENNIFER L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FAULK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PERKINS
Other - Last Name:FAULK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 21983
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1983
Mailing Address - Country:US
Mailing Address - Phone:661-342-3451
Mailing Address - Fax:
Practice Address - Street 1:9500 FLUSHING QUAIL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2674
Practice Address - Country:US
Practice Address - Phone:661-201-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP4275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist