Basic Information
| Provider Information | |||||||||
| NPI: | 1134391394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORTH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | VERA | ||||||||
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| Credential: | M.A.,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3825 DUGAN FARMS | ||||||||
| Address2: | |||||||||
| City: | PERRY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440818641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403610482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4533 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440046930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 03/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP 8123 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.