Provider Demographics
NPI:1245661180
Name:SYLVESTER, JENNIFER (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SYLVESTER
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 1:146 LAKE ST N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2518
Mailing Address - Country:US
Mailing Address - Phone:651-464-5235
Mailing Address - Fax:763-230-1989
Practice Address - Street 1:146 LAKE ST N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2518
Practice Address - Country:US
Practice Address - Phone:651-464-5235
Practice Address - Fax:763-230-1989
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist