Provider Demographics
NPI:1336301803
Name:KING, JENNIFER MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 LOMAS DEL SUR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5750
Mailing Address - Country:US
Mailing Address - Phone:956-729-7555
Mailing Address - Fax:956-729-7886
Practice Address - Street 1:2110 LOMAS DEL SUR
Practice Address - Street 2:SUITE 114
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5750
Practice Address - Country:US
Practice Address - Phone:956-729-7555
Practice Address - Fax:956-729-7886
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21079401Medicaid