Provider Demographics
NPI:1013670579
Name:SOBRERO, JENNIFER SUZANNE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:SOBRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:JENNER
Mailing Address - State:CA
Mailing Address - Zip Code:95450-0123
Mailing Address - Country:US
Mailing Address - Phone:760-889-5125
Mailing Address - Fax:
Practice Address - Street 1:530 7TH AVE # M1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4878
Practice Address - Country:US
Practice Address - Phone:760-889-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist