Provider Demographics
NPI:1487831715
Name:WESTON, JENNIFER ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:WESTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:3014 WILD TAMARIND BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9367
Mailing Address - Country:US
Mailing Address - Phone:727-743-3022
Mailing Address - Fax:321-281-4942
Practice Address - Street 1:3014 WILD TAMARIND BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9367
Practice Address - Country:US
Practice Address - Phone:727-743-3022
Practice Address - Fax:321-281-4942
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA 10001235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000246300Medicaid