Provider Demographics
NPI:1396390969
Name:CARMONA GARCIA, JENNIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:CARMONA GARCIA
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 1:8027 FERNDALE OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3895
Mailing Address - Country:US
Mailing Address - Phone:787-370-2993
Mailing Address - Fax:
Practice Address - Street 1:8027 FERNDALE OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3895
Practice Address - Country:US
Practice Address - Phone:787-370-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16639235Z00000X
TX115415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist