Provider Demographics
NPI:1205953494
Name:LOVELL, JEANNINE A (SLP)
Entity type:Individual
Prefix:MISS
First Name:JEANNINE
Middle Name:A
Last Name:LOVELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 TRUMPETFISH LANE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5603
Mailing Address - Country:US
Mailing Address - Phone:352-238-0084
Mailing Address - Fax:
Practice Address - Street 1:11463 CORTEZ BLVD
Practice Address - Street 2:BROOKSVILLE REHAB 2000
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7367
Practice Address - Country:US
Practice Address - Phone:352-592-1114
Practice Address - Fax:352-592-1190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist