Provider Demographics
NPI:1750821617
Name:STOEP, JENNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:STOEP
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:WERKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 BROOKLYN AVE
Mailing Address - Street 2:APT 6J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 BROOKLYN AVE
Practice Address - Street 2:APT 6J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3249
Practice Address - Country:US
Practice Address - Phone:616-915-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025939-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist