Provider Demographics
NPI:1639652936
Name:DUXBURY, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DUXBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 2ND AVE UNIT 3089
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2998
Mailing Address - Country:US
Mailing Address - Phone:401-405-1779
Mailing Address - Fax:
Practice Address - Street 1:275 2ND AVE UNIT 3089
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2998
Practice Address - Country:US
Practice Address - Phone:401-405-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2023-06-20
Deactivation Date:2023-05-22
Deactivation Code:
Reactivation Date:2023-06-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist