Provider Demographics
NPI:1780903807
Name:BUCHMEYER, JENNIFER M (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BUCHMEYER
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 1:20808 GLADES CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2610
Mailing Address - Country:US
Mailing Address - Phone:772-461-9558
Mailing Address - Fax:
Practice Address - Street 1:20808 GLADES CUT OFF RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2610
Practice Address - Country:US
Practice Address - Phone:772-461-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889847200Medicaid