Provider Demographics
NPI:1275862104
Name:REIGELUTH, JENNIFER (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:REIGELUTH
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 1:9745 COVINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9166
Mailing Address - Country:US
Mailing Address - Phone:317-577-9013
Mailing Address - Fax:
Practice Address - Street 1:11550 N MERIDIAN ST
Practice Address - Street 2:SUITE 312
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6956
Practice Address - Country:US
Practice Address - Phone:317-815-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004678A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist