Provider Demographics
NPI:1982959318
Name:JENNER, JUDY ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:JENNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 CARRICK BEND CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4601
Mailing Address - Country:US
Mailing Address - Phone:661-599-6769
Mailing Address - Fax:239-643-5908
Practice Address - Street 1:671 GOODLETTE RD N
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-434-9512
Practice Address - Fax:239-643-5908
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist