Provider Demographics
NPI:1689336315
Name:BAINS, JENNA MARIE (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:BAINS
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 ROSEHILL DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8518
Mailing Address - Country:US
Mailing Address - Phone:352-617-3391
Mailing Address - Fax:
Practice Address - Street 1:2515 SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5835
Practice Address - Country:US
Practice Address - Phone:407-703-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist