Provider Demographics
NPI:1992845408
Name:CLOUD, JENNIFER MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MILL CREEK CRT.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8301
Mailing Address - Country:US
Mailing Address - Phone:850-656-1600
Mailing Address - Fax:850-656-9200
Practice Address - Street 1:2424 MILLCREEK CRT.
Practice Address - Street 2:SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8301
Practice Address - Country:US
Practice Address - Phone:850-656-1600
Practice Address - Fax:850-656-9200
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist