Provider Demographics
NPI:1215900550
Name:DUNBAR, JENNIFER L (SLP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:L
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-5811
Mailing Address - Country:US
Mailing Address - Phone:941-321-2577
Mailing Address - Fax:941-343-9402
Practice Address - Street 1:3409 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-5811
Practice Address - Country:US
Practice Address - Phone:941-321-2577
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902FOtherBCBS OF FL
FL887475100Medicaid