Provider Demographics
NPI:1942223540
Name:VOLTZ, JENNIFER P (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:VOLTZ
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 1:10397 SPRUCE PINE CT.
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-287-9734
Mailing Address - Fax:561-244-9627
Practice Address - Street 1:8911 DANIELS PARKWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-561-2778
Practice Address - Fax:239-561-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002342400Medicaid
FLSA8378OtherSLP #