Provider Demographics
NPI:1598761850
Name:VERT, JENNIFER ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:VERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:457 SW 148TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1975
Mailing Address - Country:US
Mailing Address - Phone:206-246-8677
Mailing Address - Fax:206-431-2922
Practice Address - Street 1:457 SW 148TH ST
Practice Address - Street 2:STE 101
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1975
Practice Address - Country:US
Practice Address - Phone:206-246-8677
Practice Address - Fax:206-431-2922
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00003619231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9052176Medicaid
Q13739Medicare UPIN
WA8803013Medicare ID - Type Unspecified