NPI | 1053441832 |
---|---|
Former Name | JENNIFER LYNN WENTZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 58 015143) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP 16481) |
Enumeration Date | 2007-03-07 |
Last Update Date | 2010-12-10 |