Provider Demographics
NPI:1770639338
Name:MIDDLEMAS, JENNIE (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MIDDLEMAS
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 1:4370 FUSCHIA CIR S
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5431
Mailing Address - Country:US
Mailing Address - Phone:561-626-9886
Mailing Address - Fax:
Practice Address - Street 1:2532 W INDIANTOWN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3935
Practice Address - Country:US
Practice Address - Phone:561-748-5430
Practice Address - Fax:561-748-5442
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist