Provider Demographics
NPI:1013249127
Name:NASLUCHACZ, JENNIFER (MSR, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NASLUCHACZ
Suffix:
Gender:F
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CANTERBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-4903
Mailing Address - Country:US
Mailing Address - Phone:580-480-0190
Mailing Address - Fax:
Practice Address - Street 1:180 MONTGOMERY ST
Practice Address - Street 2:20TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4205
Practice Address - Country:US
Practice Address - Phone:415-512-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4503OtherOKLAHOMA LICENSE
12063476OtherASHA
CA15609OtherCALIFORNIA LICENSE