Provider Demographics
NPI:1750860680
Name:LUNA, JENNIFER DENISE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:LUNA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 DESERT WILLOW LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-4026
Mailing Address - Country:US
Mailing Address - Phone:956-251-7413
Mailing Address - Fax:
Practice Address - Street 1:10721 DESERT WILLOW LOOP
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-4026
Practice Address - Country:US
Practice Address - Phone:956-251-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist