Provider Demographics
NPI:1437133469
Name:JENNIFER DELUTIO INC
Entity Type:Organization
Organization Name:JENNIFER DELUTIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DELATIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSSP CCC SLP
Authorized Official - Phone:360-279-1905
Mailing Address - Street 1:2011 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-720-9685
Mailing Address - Fax:360-279-9459
Practice Address - Street 1:231 SE BARRINGTON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-279-1905
Practice Address - Fax:360-279-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN