Provider Demographics
NPI:1184751653
Name:ENOTE BECKER, JENNIFER DIANE (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DIANE
Last Name:ENOTE BECKER
Suffix:
Gender:F
Credentials:MSCCC-SLP
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 1691
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-1691
Mailing Address - Country:US
Mailing Address - Phone:505-782-4294
Mailing Address - Fax:505-782-5879
Practice Address - Street 1:22 SALT LAKE ROAD
Practice Address - Street 2:DOWA YALANNE ELEMENTARY
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-4441
Practice Address - Fax:505-782-5879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM000G6294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000G6294Medicaid