| Doctor Name: | MRS. JENICA L TABER |
| NPI Number: | 1952561946 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS,CCC-SLP |
| License Number: | 22004455A |
| Business Practice Address: | 1111 Ronald Reagan Pkwy Avon, IN - 461237085 |
| Business Phone Number: | 3172173079 |
| Business Fax Number: | 3172173073 |
| Mailing Address: | 8440 Wanda Lake Dr, CAMBY |
| State: | IN |
| Postal Code: | 461138718 |
| Phone Number: | 3176264923 |
| Fax Number: | 3172173073 |
| NPI Enumeration Date: | 06/12/2008 |
| NPI Last Update Date: | 06/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 22004455A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| 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 |