Provider Demographics
NPI:1831873090
Name:FREIMARK, JENIFER MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:MICHELLE
Last Name:FREIMARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:MICHELLE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1958 MILDRED DR
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9445
Mailing Address - Country:US
Mailing Address - Phone:989-701-4909
Mailing Address - Fax:
Practice Address - Street 1:220 W HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1220
Practice Address - Country:US
Practice Address - Phone:989-701-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist