Basic Information
| Provider Information | |||||||||
| NPI: | 1861799595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITNEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12220 BRUCE B DOWNS BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336129201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278987451 | ||||||||
| FaxNumber: | 9417455667 | ||||||||
| Practice Location | |||||||||
| Address1: | 12220 BRUCE B DOWNS BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336129201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278987451 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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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 | SA10836 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.