Provider Demographics
NPI:1568936672
Name:KEMP, JENNA BERRY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BERRY
Last Name:KEMP
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5408
Mailing Address - Country:US
Mailing Address - Phone:972-954-7053
Mailing Address - Fax:
Practice Address - Street 1:1506 N GREENVILLE AVE STE 230
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8629
Practice Address - Country:US
Practice Address - Phone:214-785-4608
Practice Address - Fax:888-353-7183
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist