Provider Demographics
NPI:1427829571
Name:OBERG, JENIFER (MS SLP-CF)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:OBERG
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:OBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:136 ALOE TREE LN
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-4254
Mailing Address - Country:US
Mailing Address - Phone:724-272-3968
Mailing Address - Fax:
Practice Address - Street 1:1102 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1728
Practice Address - Country:US
Practice Address - Phone:512-462-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist