Provider Demographics
NPI:1588406581
Name:ALLEN, JENNIFER LEIGH (MS ED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 SW 115TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8718
Mailing Address - Country:US
Mailing Address - Phone:352-816-0215
Mailing Address - Fax:
Practice Address - Street 1:200 CLUBHOUSE VISTA RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:FL
Practice Address - Zip Code:32702-9639
Practice Address - Country:US
Practice Address - Phone:800-343-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist