Provider Demographics
NPI:1639693625
Name:NGUYEN, JENNY (SLP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:NGUYEN
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 1:750 FORT WORTH AVE APT 221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1832
Mailing Address - Country:US
Mailing Address - Phone:832-484-0487
Mailing Address - Fax:
Practice Address - Street 1:106 S JACKSON ST STE 1
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3795
Practice Address - Country:US
Practice Address - Phone:972-938-2954
Practice Address - Fax:972-938-2946
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist