Provider Demographics
NPI:1508550039
Name:WALSH, JENNIFER GLORIA (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:GLORIA
Last Name:WALSH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S 18TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3517
Mailing Address - Country:US
Mailing Address - Phone:401-598-6970
Mailing Address - Fax:
Practice Address - Street 1:9050 384TH AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9637
Practice Address - Country:US
Practice Address - Phone:425-888-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist