Provider Demographics
NPI:1154527687
Name:USHKA, JENNIFER MARIE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:USHKA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 DARNELL DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1705
Mailing Address - Country:US
Mailing Address - Phone:863-414-3676
Mailing Address - Fax:727-318-4057
Practice Address - Street 1:4501 DARNELL DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872
Practice Address - Country:US
Practice Address - Phone:863-414-3676
Practice Address - Fax:727-318-4057
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812156700Medicaid
FL892321300Medicaid