Provider Demographics
NPI:1891043501
Name:JENNINGS, KATIE (BS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2707
Mailing Address - Country:US
Mailing Address - Phone:781-821-3499
Mailing Address - Fax:
Practice Address - Street 1:1 WHITMAN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2707
Practice Address - Country:US
Practice Address - Phone:781-821-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist