Individual
JENNIFER LYNN ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD CCC SLP
Contact information
Practice address
127 WALNUT, GREENVILLE, MO 63944-0320
(573) 224-3916
(573) 224-3412
Mailing address
858 HIGHWAY F, HARVIELL, MO 63945-8126
(573) 224-3916
(573) 224-3412
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2004029091
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
467340808
—
MO
Enumeration date
04/27/2007
Last updated
09/10/2010
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