Provider Demographics
NPI:1770143448
Name:ENGLISH, JENNA CHRISTINE (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:CHRISTINE
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SWEETBROOM CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-8695
Mailing Address - Country:US
Mailing Address - Phone:813-294-2129
Mailing Address - Fax:
Practice Address - Street 1:2241 GREEN HEDGES WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6966
Practice Address - Country:US
Practice Address - Phone:813-973-1033
Practice Address - Fax:844-495-7168
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist