Provider Demographics
NPI:1609340918
Name:DALGARN, JENNA (SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:DALGARN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MARYLYN AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6269
Mailing Address - Country:US
Mailing Address - Phone:814-207-7172
Mailing Address - Fax:
Practice Address - Street 1:500 E MARYLYN AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6269
Practice Address - Country:US
Practice Address - Phone:814-238-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16871235Z00000X
PASL014915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist