Provider Demographics
NPI:1346530326
Name:DENNISON, JENNIFER LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DENNISON
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 1:658 PICCADILLY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3800
Mailing Address - Country:US
Mailing Address - Phone:304-617-2924
Mailing Address - Fax:304-617-2924
Practice Address - Street 1:658 PICCADILLY ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3800
Practice Address - Country:US
Practice Address - Phone:304-617-2924
Practice Address - Fax:304-617-2924
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist