Provider Demographics
NPI:1679770044
Name:ACKETT, JENNIFER (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:ACKETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W TIMBERLANE DR
Mailing Address - Street 2:STE 800
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0959
Mailing Address - Country:US
Mailing Address - Phone:813-707-9362
Mailing Address - Fax:813-443-8084
Practice Address - Street 1:1601 W TIMBERLANE DR
Practice Address - Street 2:STE 800
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0959
Practice Address - Country:US
Practice Address - Phone:813-707-9362
Practice Address - Fax:813-443-8084
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010098600Medicaid