Provider Demographics
NPI:1972842276
Name:FENTON, JANE A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:FENTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 S 50 E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2140
Mailing Address - Country:US
Mailing Address - Phone:435-512-4968
Mailing Address - Fax:
Practice Address - Street 1:865 S 50 E
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2140
Practice Address - Country:US
Practice Address - Phone:435-512-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8294295-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist