Provider Demographics
NPI:1427422773
Name:SKEHAN, JENNIFER DEBORAH (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEBORAH
Last Name:SKEHAN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 AVENIDA DEL ORO
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5829
Mailing Address - Country:US
Mailing Address - Phone:760-945-6500
Mailing Address - Fax:760-945-6535
Practice Address - Street 1:1949 AVENIDA DEL ORO
Practice Address - Street 2:SUITE 118
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5829
Practice Address - Country:US
Practice Address - Phone:760-945-6500
Practice Address - Fax:760-945-6535
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist