Provider Demographics
NPI:1952884629
Name:XENAKES, JENNIFER (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:XENAKES
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WIMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19703
Mailing Address - Country:US
Mailing Address - Phone:302-793-5000
Mailing Address - Fax:
Practice Address - Street 1:1311 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:WIMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19703
Practice Address - Country:US
Practice Address - Phone:302-793-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service