Provider Demographics
NPI:1841928223
Name:WAKEFIELD, JENNIFER DENISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:WAKEFIELD
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 1:307 SLEEPY HOLLOW DR APT 416
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4368
Mailing Address - Country:US
Mailing Address - Phone:936-404-4456
Mailing Address - Fax:
Practice Address - Street 1:2000 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4756
Practice Address - Country:US
Practice Address - Phone:281-592-7362
Practice Address - Fax:281-592-1633
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist