Provider Demographics
NPI:1316358476
Name:AXELGARD, JENNIFER HANSEN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HANSEN
Last Name:AXELGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3278 CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2714
Mailing Address - Country:US
Mailing Address - Phone:801-602-8081
Mailing Address - Fax:
Practice Address - Street 1:10400 HAMBURG RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139-1204
Practice Address - Country:US
Practice Address - Phone:810-231-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist