Provider Demographics
NPI:1730363474
Name:DOMINICK, JENNIFER TOI
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:TOI
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 EMACK AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4004
Mailing Address - Country:US
Mailing Address - Phone:301-577-6883
Mailing Address - Fax:301-459-6933
Practice Address - Street 1:5608 EMACK AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4004
Practice Address - Country:US
Practice Address - Phone:301-577-6883
Practice Address - Fax:301-459-6933
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency