Individual
MRS. JENNIFER S PROVDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
49 WAGON LN, CHERRY HILL, NJ 08002-1561
(856) 482-9543
Mailing address
49 WAGON LN, CHERRY HILL, NJ 08002-1561
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00596700
NJ
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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