Provider Demographics
NPI:1467554915
Name:BROWN, JENNIFER BARNIDGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BARNIDGE
Last Name:BROWN
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 1:6143 PICKWICK RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-9401
Mailing Address - Country:US
Mailing Address - Phone:850-766-2616
Mailing Address - Fax:850-894-4313
Practice Address - Street 1:6143 PICKWICK RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-9401
Practice Address - Country:US
Practice Address - Phone:850-766-2616
Practice Address - Fax:850-894-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0045643Medicaid