Provider Demographics
NPI:1023102191
Name:ISAAC, JENNIFER L (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ISAAC
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537A GREEN VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8168
Mailing Address - Country:US
Mailing Address - Phone:801-580-4050
Mailing Address - Fax:
Practice Address - Street 1:537A GREEN VILLAGE CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8168
Practice Address - Country:US
Practice Address - Phone:801-580-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-02-06
Deactivation Date:2006-11-08
Deactivation Code:
Reactivation Date:2009-02-06
Provider Licenses
StateLicense IDTaxonomies
PASL 008589235Z00000X
TX103242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist