Basic Information
| Provider Information | |||||||||
| NPI: | 1952500480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBERT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WALLIE CLEMENTS RD | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424627020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703893045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 509 N CARRIER ST | ||||||||
| Address2: | |||||||||
| City: | MORGANFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424371201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703893513 | ||||||||
| FaxNumber: | 2703894706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2007 | ||||||||
| LastUpdateDate: | 07/14/2007 | ||||||||
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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 | KY-07-014 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.