Provider Demographics
NPI:1295330660
Name:PLANTE, JENNIFER (MACCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PLANTE
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 FUNK RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9069
Mailing Address - Country:US
Mailing Address - Phone:419-512-9940
Mailing Address - Fax:
Practice Address - Street 1:890 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-2565
Practice Address - Country:US
Practice Address - Phone:419-774-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5200235Z00000X
3747P1801X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant