Provider Demographics
NPI:1700943149
Name:DARLEY, JENNIFER FAITH (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAITH
Last Name:DARLEY
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E CALL ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3405
Mailing Address - Country:US
Mailing Address - Phone:904-964-8900
Mailing Address - Fax:
Practice Address - Street 1:603 E CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3405
Practice Address - Country:US
Practice Address - Phone:904-964-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686749Medicare ID - Type UnspecifiedSPEECH THERAPIST