Provider Demographics
NPI:1679807663
Name:GALLAGHER, JENNIFER JOY (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOY
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21775 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8748
Mailing Address - Country:US
Mailing Address - Phone:813-340-2623
Mailing Address - Fax:
Practice Address - Street 1:3395 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-3765
Practice Address - Country:US
Practice Address - Phone:952-939-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist