Provider Demographics
NPI:1780925602
Name:HERNANDEZ, JENNIFER KATE
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATE
Other - Last Name:GAAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1859 CALAVERAS AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-1148
Mailing Address - Country:US
Mailing Address - Phone:909-732-5322
Mailing Address - Fax:
Practice Address - Street 1:5945 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1800
Practice Address - Country:US
Practice Address - Phone:951-779-1966
Practice Address - Fax:951-779-1933
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 14502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant