Provider Demographics
NPI:1215271416
Name:BOOTH, JENNIFER LYNN (MS, CFY-SLP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MS, CFY-SLP
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Mailing Address - Street 1:1111 N MISSION PARK BLVD
Mailing Address - Street 2:#1088
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3988
Mailing Address - Country:US
Mailing Address - Phone:815-762-0723
Mailing Address - Fax:480-899-0330
Practice Address - Street 1:1111 N MISSION PARK BLVD
Practice Address - Street 2:#1088
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3988
Practice Address - Country:US
Practice Address - Phone:815-762-0723
Practice Address - Fax:480-899-0330
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZTSLP5742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist