Provider Demographics
NPI:1063142297
Name:BELEN, JENNIFER MICHELE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:BELEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELE
Other - Last Name:PATINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:911 REMINGTON GREEN DR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6909
Mailing Address - Country:US
Mailing Address - Phone:862-202-1408
Mailing Address - Fax:
Practice Address - Street 1:911 REMINGTON GREEN DR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6909
Practice Address - Country:US
Practice Address - Phone:862-202-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00739500235Z00000X
FLSA20499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist