Doctor Name: | ANDREW JENNISON |
NPI Number: | 1710372883 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CF-SLP |
License Number: | SLPI.SI.60547212 |
Business Practice Address: | 17201 15th Ave Ne Shoreline, WA - 981555129 |
Business Phone Number: | 2063649336 |
Business Fax Number: | |
Mailing Address: | 25117 Sw Parkway Ave Ste D, WILSONVILLE |
State: | OR |
Postal Code: | 970709697 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/05/2015 |
NPI Last Update Date: | 04/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLPI.SI.60547212 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |