Provider Demographics
NPI:1720162266
Name:HERBERT, JENNIFER (ST)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21703 KINGSLAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2521
Mailing Address - Country:US
Mailing Address - Phone:281-769-1015
Mailing Address - Fax:281-717-8947
Practice Address - Street 1:21703 KINGSLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2521
Practice Address - Country:US
Practice Address - Phone:281-769-1015
Practice Address - Fax:281-717-8947
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist