Provider Demographics
NPI:1386285518
Name:KALICH, JENNY
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:KALICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5436
Mailing Address - Country:US
Mailing Address - Phone:321-277-1587
Mailing Address - Fax:
Practice Address - Street 1:618 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5436
Practice Address - Country:US
Practice Address - Phone:321-277-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10661235Z00000X
FLSZ9356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist