Provider Demographics
NPI:1124083050
Name:LANTZ, JENNIFER LYNN (MS, CCC-A)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LANTZ
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580-I RITCHIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3922
Mailing Address - Country:US
Mailing Address - Phone:410-647-7795
Mailing Address - Fax:410-315-8823
Practice Address - Street 1:1324 BELMONT AVE
Practice Address - Street 2:STE 202
Practice Address - City:SALLSBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4543
Practice Address - Country:US
Practice Address - Phone:410-549-9552
Practice Address - Fax:410-315-8823
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
314GMedicare PIN
115P314GMedicare ID - Type Unspecified