Provider Demographics
NPI:1568097483
Name:DURAN, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DURAN
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 1:1426 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8067
Mailing Address - Country:US
Mailing Address - Phone:559-321-4266
Mailing Address - Fax:
Practice Address - Street 1:1426 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8067
Practice Address - Country:US
Practice Address - Phone:559-321-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2024-07-25
Deactivation Date:2024-06-20
Deactivation Code:
Reactivation Date:2024-07-03
Provider Licenses
StateLicense IDTaxonomies
CA19286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist