Provider Demographics
NPI:1811483274
Name:ZUNIGA, JENNIFER (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZUNIGA
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 1:22365 BARTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5037
Mailing Address - Country:US
Mailing Address - Phone:909-824-2899
Mailing Address - Fax:909-687-2326
Practice Address - Street 1:22365 BARTON RD STE 104
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5037
Practice Address - Country:US
Practice Address - Phone:909-457-6055
Practice Address - Fax:909-687-2326
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2023-06-09
Deactivation Date:2023-03-29
Deactivation Code:
Reactivation Date:2023-05-16
Provider Licenses
StateLicense IDTaxonomies
CA34383235Z00000X
CARBT-18-58783106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician