Provider Demographics
NPI:1528578945
Name:STUART, JENNIFER LEA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:STUART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:1028 S WALTER REED DR APT 319
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-0821
Mailing Address - Country:US
Mailing Address - Phone:405-812-3204
Mailing Address - Fax:
Practice Address - Street 1:1818 NEWTON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1017
Practice Address - Country:US
Practice Address - Phone:405-812-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty