Provider Demographics
NPI:1750705406
Name:STALLINGS, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STALLINGS
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 1:7334 N ELYRIA RD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9790
Mailing Address - Country:US
Mailing Address - Phone:419-846-3519
Mailing Address - Fax:419-846-3584
Practice Address - Street 1:7334 N ELYRIA RD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9790
Practice Address - Country:US
Practice Address - Phone:419-846-3517
Practice Address - Fax:419-846-3584
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist