Provider Demographics
NPI:1710589791
Name:TINSLEY, JENNIFER IRVING
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRVING
Last Name:TINSLEY
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 1:6901 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3780
Mailing Address - Country:US
Mailing Address - Phone:410-887-1318
Mailing Address - Fax:
Practice Address - Street 1:3200 ELBA DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4401
Practice Address - Country:US
Practice Address - Phone:609-374-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06293235Z00000X
MD06293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist