Provider Demographics
NPI:1255338380
Name:GARCIA, JENNIFER LUNDGREN (AUD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LUNDGREN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:NORTH BUILDING, SUITE 103
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2392
Mailing Address - Country:US
Mailing Address - Phone:413-525-7979
Mailing Address - Fax:413-525-8303
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:# N103
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2392
Practice Address - Country:US
Practice Address - Phone:413-525-7979
Practice Address - Fax:413-525-8303
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA698231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104076Medicaid
MA5104076Medicaid