Provider Demographics
NPI:1972351500
Name:LORD, JENNIFER HILARY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HILARY
Last Name:LORD
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:HILARY
Other - Last Name:ESTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5206 DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2302
Mailing Address - Country:US
Mailing Address - Phone:314-779-6846
Mailing Address - Fax:
Practice Address - Street 1:9835 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1243
Practice Address - Country:US
Practice Address - Phone:314-968-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024016165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist