Provider Demographics
NPI:1194074120
Name:HUMMEL, JEANNETTE BEVERLY (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:BEVERLY
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 N HIGHWAY A1A
Mailing Address - Street 2:APT 506
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-8369
Mailing Address - Country:US
Mailing Address - Phone:440-413-9198
Mailing Address - Fax:
Practice Address - Street 1:4250 N HIGHWAY A1A
Practice Address - Street 2:APT 506
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-8369
Practice Address - Country:US
Practice Address - Phone:440-413-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist