Provider Demographics
NPI:1265221048
Name:MIDDENDORF, JENNIFER ANNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:MIDDENDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W OAKDALE AVE APT 801
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5627
Mailing Address - Country:US
Mailing Address - Phone:513-560-6216
Mailing Address - Fax:
Practice Address - Street 1:4022 W NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4021
Practice Address - Country:US
Practice Address - Phone:312-685-1795
Practice Address - Fax:312-500-5039
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist