Provider Demographics
NPI:1194873505
Name:ALTEMUELLER, JENNIFER R (SP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:ALTEMUELLER
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19413 BONANZA KING DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-7630
Mailing Address - Country:US
Mailing Address - Phone:530-917-9701
Mailing Address - Fax:530-348-6971
Practice Address - Street 1:19413 BONANZA KING DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-7630
Practice Address - Country:US
Practice Address - Phone:530-917-9701
Practice Address - Fax:530-348-6971
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist