Provider Demographics
NPI:1134196595
Name:MARDEN, JENNIFER M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MARDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CONGREVE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1913
Mailing Address - Country:US
Mailing Address - Phone:617-327-0693
Mailing Address - Fax:
Practice Address - Street 1:11 CONGREVE ST
Practice Address - Street 2:APT 2
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1913
Practice Address - Country:US
Practice Address - Phone:617-327-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist