Provider Demographics
NPI:1992838130
Name:MENZEL, JENNIFER MARTINY (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARTINY
Last Name:MENZEL
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MARTINY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:65 E BLOOMFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9775
Mailing Address - Country:US
Mailing Address - Phone:317-409-0612
Mailing Address - Fax:
Practice Address - Street 1:65 E BLOOMFIELD LANE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9775
Practice Address - Country:US
Practice Address - Phone:317-409-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004197A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist