Provider Demographics
NPI:1285309005
Name:BARTLEBAUGH, JENNIFER TRACY (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TRACY
Last Name:BARTLEBAUGH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BRYCE CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5100
Mailing Address - Country:US
Mailing Address - Phone:410-322-4164
Mailing Address - Fax:
Practice Address - Street 1:2311 WILLOUGHBY BEACH RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3419
Practice Address - Country:US
Practice Address - Phone:410-612-1518
Practice Address - Fax:410-612-1523
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02348L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist