Provider Demographics
NPI:1497574222
Name:BARRETT, JEREMY THOMAS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:THOMAS
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 HOBSON DR
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1405
Mailing Address - Country:US
Mailing Address - Phone:814-762-3604
Mailing Address - Fax:
Practice Address - Street 1:5571 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3243
Practice Address - Country:US
Practice Address - Phone:724-493-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL018059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist