Provider Demographics
NPI:1104402387
Name:CROSS, JHENNA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JHENNA RAE
Middle Name:
Last Name:CROSS
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 1:6131 SKYLARKCREST DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-1785
Mailing Address - Country:US
Mailing Address - Phone:810-247-0818
Mailing Address - Fax:
Practice Address - Street 1:6131 SKYLARKCREST DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-1785
Practice Address - Country:US
Practice Address - Phone:810-247-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist