Provider Demographics
NPI:1992991293
Name:MEARS, JENNIFER LIORAH (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIORAH
Last Name:MEARS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47015 BEAR CLAW RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9499
Mailing Address - Country:US
Mailing Address - Phone:305-803-9139
Mailing Address - Fax:
Practice Address - Street 1:47015 BEAR CLAW RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:FL
Practice Address - Zip Code:32702-9499
Practice Address - Country:US
Practice Address - Phone:305-803-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY292103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist