Provider Demographics
NPI:1124852439
Name:DEVEAU, JENNIFER SUSAN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSAN
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-1481
Mailing Address - Country:US
Mailing Address - Phone:805-748-9895
Mailing Address - Fax:
Practice Address - Street 1:2050 S BROADWAY STE F
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8801
Practice Address - Country:US
Practice Address - Phone:805-621-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9028237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist