Provider Demographics
NPI:1851846158
Name:RADFORD, JENNI (SLP)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:
Last Name:RADFORD
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 1:607 E 460 S
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-9528
Mailing Address - Country:US
Mailing Address - Phone:435-535-1466
Mailing Address - Fax:
Practice Address - Street 1:607 E 460 S
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-9528
Practice Address - Country:US
Practice Address - Phone:435-535-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24548235Z00000X
UT5859734-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist