Provider Demographics
NPI:1497401210
Name:SUMNER, JENNIFER LYN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:SUMNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 RIVERSTONE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5724
Mailing Address - Country:US
Mailing Address - Phone:713-740-5276
Mailing Address - Fax:
Practice Address - Street 1:1801 RIVERSTONE RANCH RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5724
Practice Address - Country:US
Practice Address - Phone:713-740-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist