Provider Demographics
NPI:1790864965
Name:FANIEL, JENNIFER L (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FANIEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 BEHRING WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1609
Mailing Address - Country:US
Mailing Address - Phone:877-852-0246
Mailing Address - Fax:877-904-5749
Practice Address - Street 1:3801 PGA BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2758
Practice Address - Country:US
Practice Address - Phone:877-852-0246
Practice Address - Fax:877-904-5749
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist