Provider Demographics
NPI:1659825388
Name:TALBERT, JENA BLOODSWORTH (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:BLOODSWORTH
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 LONG FLOWER CT
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1590
Mailing Address - Country:US
Mailing Address - Phone:504-259-2999
Mailing Address - Fax:
Practice Address - Street 1:1421 FM 359 RD
Practice Address - Street 2:H
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2023
Practice Address - Country:US
Practice Address - Phone:281-232-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist