Provider Demographics
NPI:1376984005
Name:MARR, JENNA LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LYNN
Last Name:MARR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:BRUSIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:11930 WHITMORE LAKE RD
Mailing Address - Street 2:SUITE I-M
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189
Mailing Address - Country:US
Mailing Address - Phone:734-449-4649
Mailing Address - Fax:734-449-4669
Practice Address - Street 1:138 W. HIGHLAND RD.
Practice Address - Street 2:SUITE 500-600
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-376-4831
Practice Address - Fax:517-376-4833
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist