Provider Demographics
NPI:1851844005
Name:CARTER, JENNIFER (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 NE 48TH CT
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7922
Mailing Address - Country:US
Mailing Address - Phone:323-455-6294
Mailing Address - Fax:
Practice Address - Street 1:125 ALMA BLVD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4345
Practice Address - Country:US
Practice Address - Phone:321-453-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-24
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist