Basic Information
| Provider Information | |||||||||
| NPI: | 1043596554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | CARLISLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 TEABURY LN | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077551250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322225797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14 BRIDGEWATERS DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OCEANPORT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077571162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325426600 | ||||||||
| FaxNumber: | 7325426606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2011 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 41YS00290000 | NJ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.