Provider Demographics
NPI:1326662032
Name:JENNISON, CARLA IRENE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:IRENE
Last Name:JENNISON
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 1:18 CATE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3514
Mailing Address - Country:US
Mailing Address - Phone:603-817-0323
Mailing Address - Fax:
Practice Address - Street 1:1 BLUE HAWK DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4429
Practice Address - Country:US
Practice Address - Phone:603-395-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist