Provider Demographics
NPI:1841330982
Name:STARKENBURG, JENNIFER R (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:STARKENBURG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8505 CEDARHOME DR
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9539
Mailing Address - Country:US
Mailing Address - Phone:206-235-1565
Mailing Address - Fax:
Practice Address - Street 1:820 S SKAGIT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2418
Practice Address - Country:US
Practice Address - Phone:360-757-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL0000307235Z00000X
WALL00003074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL00003074OtherWA STATE DEPT OF HEALTH
WA8400483Medicaid
FLWATING FORMedicaid