Provider Demographics
NPI:1457863219
Name:GUNTHER, JENNIFER (MA,CCC-S/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:MA,CCC-S/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OWEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2516
Mailing Address - Country:US
Mailing Address - Phone:847-445-7296
Mailing Address - Fax:
Practice Address - Street 1:610 HWY O
Practice Address - Street 2:
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65038
Practice Address - Country:US
Practice Address - Phone:573-374-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist