Provider Demographics
NPI:1295271732
Name:KRICKEBERG, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KRICKEBERG
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 1:600 W RAY RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7263
Mailing Address - Country:US
Mailing Address - Phone:480-855-0474
Mailing Address - Fax:
Practice Address - Street 1:600 W RAY RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7263
Practice Address - Country:US
Practice Address - Phone:480-855-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant