Provider Demographics
NPI:1083444533
Name:MORENO, JENNIFER (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7537 33RD PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2948
Mailing Address - Country:US
Mailing Address - Phone:806-790-9126
Mailing Address - Fax:
Practice Address - Street 1:10711 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-6183
Practice Address - Country:US
Practice Address - Phone:806-686-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist