Provider Demographics
NPI:1699436063
Name:HOMER, JENNIFER L (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HOMER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7746
Mailing Address - Country:US
Mailing Address - Phone:214-732-2211
Mailing Address - Fax:
Practice Address - Street 1:3405 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7746
Practice Address - Country:US
Practice Address - Phone:214-732-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist