Provider Demographics
NPI:1891124038
Name:SANCHEZ, JENNIFER (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2625
Mailing Address - Country:US
Mailing Address - Phone:908-456-4398
Mailing Address - Fax:
Practice Address - Street 1:208 S 4TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2625
Practice Address - Country:US
Practice Address - Phone:908-456-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP/SLP-0582235Z00000X
NJ41YS00784500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist