Provider Demographics
NPI:1780868851
Name:BARNES, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DOZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5650 N RIVERSIDE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2464
Mailing Address - Country:US
Mailing Address - Phone:817-586-8779
Mailing Address - Fax:
Practice Address - Street 1:5650 N RIVERSIDE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2464
Practice Address - Country:US
Practice Address - Phone:817-586-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80T305OtherBLUE CROSS BLUE SHIELD
TX203178301Medicaid