Individual
MRS. JENNIFER MOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3918 SUMAC RD, VALPARAISO, IN 46383-2110
(219) 951-7979
Mailing address
3918 SUMAC RD, VALPARAISO, IN 46383-2110
(219) 951-7979
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004299A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000489978
ANTHEM
IN
Enumeration date
01/26/2007
Last updated
07/09/2007
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