Doctor Name: | JENNIFER A. BLACK |
NPI Number: | 1982737698 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. CCC-SLP |
License Number: | SP1713 |
Business Practice Address: | 24 Falcon Dr Auburn, ME - 042104384 |
Business Phone Number: | 2077825437 |
Business Fax Number: | 2077530105 |
Mailing Address: | 16 Madison Ave, OXFORD |
State: | ME |
Postal Code: | 042703579 |
Phone Number: | 2077437035 |
Fax Number: | 2077432970 |
NPI Enumeration Date: | 03/13/2007 |
NPI Last Update Date: | 06/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP1713 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
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 |