Basic Information
| Provider Information | |||||||||
| NPI: | 1376984005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARR | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRUSIE | ||||||||
| OtherFirstName: | JENNA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | MA CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11930 WHITMORE LAKE RD | ||||||||
| Address2: | SUITE I-M | ||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344494649 | ||||||||
| FaxNumber: | 7344494669 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 W. HIGHLAND RD. | ||||||||
| Address2: | SUITE 500-600 | ||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173764831 | ||||||||
| FaxNumber: | 5173764833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101000226 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.