Provider Demographics
NPI:1871634576
Name:YEAGLE, JENNIFER DOBSON (MED, CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DOBSON
Last Name:YEAGLE
Suffix:
Gender:F
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N CAROLINE ST # 6011
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2000
Mailing Address - Country:US
Mailing Address - Phone:410-955-9259
Mailing Address - Fax:410-614-9167
Practice Address - Street 1:601 N CAROLINE ST # 6011
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2000
Practice Address - Country:US
Practice Address - Phone:410-955-9259
Practice Address - Fax:410-614-9167
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00921231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist