Provider Demographics
NPI:1336034537
Name:MAHAMA, JENNA ANN (SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:MAHAMA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:ANN
Other - Last Name:MAHAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:10029 TRANQUILITY WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-2547
Mailing Address - Country:US
Mailing Address - Phone:225-281-8562
Mailing Address - Fax:
Practice Address - Street 1:10006 N DALE MABRY HWY STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4422
Practice Address - Country:US
Practice Address - Phone:813-374-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist