Provider Demographics
NPI:1134353253
Name:RUDNICK, JENNIFER J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:RUDNICK
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 1:1951 NE 2ND AVE
Mailing Address - Street 2:I210
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2029
Mailing Address - Country:US
Mailing Address - Phone:954-249-1955
Mailing Address - Fax:954-566-5993
Practice Address - Street 1:1951 NE 2ND AVE
Practice Address - Street 2:I210
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2029
Practice Address - Country:US
Practice Address - Phone:954-249-1955
Practice Address - Fax:954-566-5993
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist