Provider Demographics
NPI:1578896742
Name:VINCENT, JENNIFER K
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 N 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3612
Mailing Address - Country:US
Mailing Address - Phone:307-840-4576
Mailing Address - Fax:307-463-2578
Practice Address - Street 1:313 N 5TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3612
Practice Address - Country:US
Practice Address - Phone:307-840-4576
Practice Address - Fax:307-463-2578
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYST-548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist