Provider Demographics
NPI:1619501889
Name:KRETSCHMAR, JENNA ROSE (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:ROSE
Last Name:KRETSCHMAR
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:ROSE
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2103 GOLDEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4171
Mailing Address - Country:US
Mailing Address - Phone:941-726-1145
Mailing Address - Fax:
Practice Address - Street 1:741 S BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2411
Practice Address - Country:US
Practice Address - Phone:941-957-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist