Provider Demographics
NPI:1710635610
Name:SPORYSZ, JENNIFER ANNE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:SPORYSZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:SPORYSZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:2245 ROGENE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3492
Mailing Address - Country:US
Mailing Address - Phone:561-301-0243
Mailing Address - Fax:
Practice Address - Street 1:11201 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1201
Practice Address - Country:US
Practice Address - Phone:410-527-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist