Provider Demographics
NPI:1992465603
Name:STAMPER, JENNIFER A (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:STAMPER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3384 E LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4232
Mailing Address - Country:US
Mailing Address - Phone:208-656-5388
Mailing Address - Fax:
Practice Address - Street 1:729 S ARAPEEN DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1218
Practice Address - Country:US
Practice Address - Phone:801-587-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12474827-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist